TITLE:
Traumatic Splenic Injuries in Khartoum, Sudan
AUTHORS:
Isameldin O. Ibrahim, Aamir A. Hamza, M. E. Ahmed
KEYWORDS:
Blunt Splenic Trauma; Nonoperative Management; Splenectomy; Splenic Injury
JOURNAL NAME:
Surgical Science,
Vol.4 No.12,
December
5,
2013
ABSTRACT:
Background: Spleen injuries are most
commonly associated with blunt abdominal trauma and represent a potentially
life-threatening condition. Objectives: To study the pattern of splenic
injuries of the patient, management instituted and its outcome at Khartoum. Patients
and Methods: This is a prospective, analytic and hospital-based multicenteric study,
conducted at the three main Teaching hospitals at Khartoum. The study was
carried over a period from April 2012 to February 2013. It includes all
patients, diagnosed as traumatic splenic injury. Excluded were patients with
history of splenic disease, iatrogenic injury or spontaneous rupture. Results: The study included 47 patients: their mean age was 26.4 years (SD ± 14.5).
Most of them 41 (87.2%) were in the first four decades of life. Males were predominant
41 (87.2%), with a male to female ratio of 6.8:1. The majority of our patients
had blunt abdominal trauma 39 (83%), of whom, road traffic accident accounted
for 51.1% and none reported cases of gunshot. Isolated splenic injury was found in 23
(48.9%), and Haemodynamic stability was seen in 27 (57.4%) on presentation. The
initial haemoglobin assessment revealed ere diagnosed as Grade V. Blood transfusion was required in 42 (89.4%).
Operative treatment was adopted in 66% (61.7% total splenectomy and 4.3% splenorrhaphy),
while selective non-operative management was successful in 16 (34%) of the
patients. Higher intra-operative grade of splenic injury was found to be significantly
associated with blunt abdominal trauma, haemodynamic instability and associated
intra-abdominal injuries. 44 patients (93.6%) were discharged home in a general
good condition. The morbidity and mortality
were seen in 8.5% and 6.4% respectively. Conclusion: Splenic
injuries usually follow blunt abdominal trauma, particularly after road
traffic accidents. It is common during the first four decades of life with
males being frequently affected. The great success rate of adopting selective
non-operative management is worthwhile.