Author(s): J. Bharath Prakash Reddy1, K. Jyothirmayi2, A. Ravitheja3, C. Ananda Reddy4, Dushyanth5
The spleen is an important organ in the body’s immune system. It is the most frequently injured organ in blunt abdominal trauma.1 Over the past several decades, diagnosis and management of splenic trauma has been evolved. The conservative, operative approach has been challenged by several reports of successful non-operative management aided by the power of modern diagnostic imaging. The aim of our prospective study was to compare non-operative management with surgery for cases of splenic injury.
We conducted a prospective study of patients admitted with blunt splenic injury to our regional hospital over a three-year period (2012-2015). Haemodynamic status upon admission, FAST examination, computed tomography2 grade of splenic tear, presence and severity of associated injuries have been taken into account to determine the treatment of choice. Therapeutic options were classified into non-operative and splenectomy.
Over a 3-year period, 24 patients were admitted with blunt splenic injury. Sixteen patients were managed operatively and eight patients non-operatively.3,4 Non-operative management failed in one patient due to continued bleeding. The majority of grades I, II, and III splenic injuries were managed non-operatively and grades IV and V were managed operatively. Blood transfusion requirement was significantly higher among the operative group, but the operative group had a significantly longer hospital stay. Among those managed non-operatively (median age 24.5 years), a number of patients were followed up with CT scans with significant radiation exposure and unknown longterm consequences.
In our experience, NOM is the treatment of choice for grade I, II and III blunt splenic injuries. Splenectomy was the chosen technique in patients who met exclusion criteria for NOM, as well as for patients with grade IV and V injury.