Objectives

• To study the various causes of splenic trauma
• To study the various clinical features of splenic trauma
• To study the methods of management of splenic trauma

Methods: A total of 52 cases admitted to various surgical wards in a tertiary care centre were studied from July 2015 to October 2017. Patients, both male and female, between the ages of 12-70 years with abdominal trauma were included in the study. These patients were analysed based on clinical history, signs and symptoms and treatment given in the way of a prospective observational study.

Results: Out of the 52 cases studied, the most common cause of splenic injury was road traffic accident (34%) followed by fall from height (25%). Out of 52 patients studied, 7 died and 45 recovered. The majority of patient who recovered were stable at presentation (64%) while in the subset who died majority were unstable (85%). On examination, 84% of the patients who recovered had abdominal signs on presentation with 16% having non abdominal signs. Out of those who died, 42.9% had non abdominal signs at presentation on examination. The most common grade of injury was grade 3 (44%) followed by grade 2 (24%) and grade 4 (22%). 25 of these patients had no co-existing injury. In those with other injuries, the most common was fractured ribs (11.5%). The most common mode of management was splenectomy (69%).

Conclusion: Our case series shows that the most common cause of splenic injury is road traffic accident followed by fall from height. Most cases are clinically stable at presentation and complain of pain in abdomen and vomiting. The most common associated injury is fractured ribs. On examination, most patients present with guarding and rigidity, with more severe cases also having signs of shock. Grade III was the most common grade of injury. The most common modality of treatment was splenectomy.

Keywords: Splenic trauma, causes, clinical features, management.

1. Manohar NN, Rao RI, Irene W, Micael R, William MS. Nonoperative management versus early operation for blunt splenic trauma in adults. SurgGynecol Obstet. 1998;166:252–7.
2. Powell M, Courcoulas A, Gardner M, Lynch J, Harbrecht BG, Udekwu AO, et al. Management of blunt splenic trauma: Significant differences between adults and children. Surgery. 1997;122:654–60
3. Peitzman AB, Heil B, Rivera L, Federle MB, Harbrecht BG, Clancy KD, et al. Blunt splenic injury in adults: Multi-institutional study of the eastern association for the surgery of trauma. J Trauma. 2000;49:177–89.
4. Iribhogbe PE, Okolo CJ. Management of splenic injuries in a university teaching hospital in Nigeria. West Afr J Med. 2009;28:308–12.
5. Wasvary H, Howells G, Villalba M, Madrazo B, Bendick P, Deangelis M, et al. Non-operative management of adult blunt splenic trauma: A 15 year experience. Am Surg. 1997;63:694–9.
6. Goan YG, Huang MS, Lin JM. Non-operative management for extensive hepatic and splenic injuries with significant haemoperitoneum in adults. J Trauma. 1998;45:360–4.
7. Mirvis SE, Whitley NO, Gens DR. Blunt splenic trauma in adults: CT-based classification and correlation with prognosis and treatment. Radiology. 1989;171:33–9.
8. Becker CD, Spring P, Glättli A, Schweizer W. Blunt splenic trauma in adults: Can CT findings be used to determine the need for surgery? AJR Am J Roentgenol. 1994;162:343–7.
9. Kohn JS, Clark DE, Isler RJ, Pope CF. Is computed tomographic grading of splenic injury useful in the nonsurgical management of blunt trauma? J Trauma. 1994;36:385–9.
10. Zafar A, Chohan K, Faheem A, Zaheera M, Riaz A. Abdominal trauma in DHQ hospital Rawalpindi. Rawalpindi Med J. 1988;17:79–81.
11. Rathore AH. Penetrating abdominal injuries. Pak J Surg. 1986;1:181–5.
12. Anderson SW, Varghese JC, Lucey BC, Burke PA, Hirsch EF, Soto JA. Blunt splenic trauma: Delayed-phase CT for differentiation of active hemorrhage from contained vascular injury in patients. Radiology. 2007;243:88–95.
13. Mucha P, Jr, Daly RC, Farnell MB. Selective management of blunt splenic trauma. J Trauma. 1986;26:970–9.
14. Jalovec LM, Boe BS, Wyffels PL. The advantages of early operation with splenorrhaphy versus nonoperative management for the blunt splenic trauma patient. Am Surg. 1993;59:698–705.
15. Iribhogbe P. Is Splenic Preservation after Blunt Splenic Injury Possible in Africa? [Last cited on 2011 Jan 11].
16. Booth WC, Cooper MJ. Surgical management of the spleen. Surgery. 1997;38:148–51.
17. Ghosh S, Symes JM, Walsh TH. Splenic repair for trauma. Br J Surg. 1988;75:1139–4
18. Targarona EM, Trias M. Laparoscopic treatment of splenic injuries. Semin Laparosc Surg. 1996;3:44–9.
19. Forsythe RM, Harbrecht BG, Peitzman AB. Blunt splenic trauma. Scand J Surg. 2006;95:146–51.

Dr Ali Zaid Anwar