Resumen de Conservative management of blunt splenic injuries in adults: Experience of 9 cases
Mohamed Farouk Allam, Mohamed A. Helmy, Ayman A. Shallal
In blunt abdominal trauma, spleen is the most frequently injured organ in adults, accounting for 25% - 30% of intra-abdominal injuries. Routine splenectomy used to be the sacrosanct treatment for splenic trauma. By 1979, numerous studies had reported the safety of non-operative management in hundreds of children all over the world. The aim of this case record review is to illustrate the role of conservative management of traumatic splenic rupture in adults based on our experience over 2 years. Our study included 9 patients (8 males and one female) with blunt abdominal trauma which proved to have splenic injuries and were all hemodynamically stable (systolic blood pressure above 90 mm Hg and heart rate below 120 beats/minute).
These patients were admitted through the Emergency Department of Al Rahba Hospital in Abu Dhabi, UAE, in the period from January 2004 to December 2005 and were managed �initially- non-operatively. During hospitalization; complete bed rest, close follow-up, and serial laboratory and clinical reevaluations, together with scans were done. The mean age of our patients was 28.4 ± 7.8 years (ranged form 21 to 45 years). During hospital stay, two patients developed delayed splenic rupture; one female with isolated grade III splenic injury and one male with grade III splenic injury and associated fracture patella, and thus both patients (22%) were treated operatively by total splenectomy. In conclusion, the majority of diagnosed splenic injuries these days are minor, low-grade injuries that are amenable to non-operative management, especially in hemodynamically stable patients with no other injuries requiring laparotomy.
