European Journal of Biomedical and Pharmaceutical Sciences

NON OPERATIVE MANAGEMENT OF SPLENIC INJURY: A NOBLE APPROCH

Virendra Kumar*, Pradeep Kumar, Anuj Sharma and C.P. Singh

ABSTRACT

Background: Nonoperative management (NOM) of blunt injury to the spleen in adults has become the standard of care in hemodynamically stable patients. This modality of treatment began in the 1970’s in paediatric patients. It is highly successful with overall failures rates from 2% to 31% (average 10.8%) - with the majority of failures occurring in the first 24 hours. The objective of this study is to determine the cause, presentation, diagnostic method, management and outcome of isolated splenic injuries from blunt abdominal trauma And to study the failure rate of non operative management of splenic injury. Methods: The conduct retrospective study comprises 39 patients with blunt abdominal trauma having isolated splenic injuries. 33 patients were managed conservatively and remaining 6 patient underwent surgical management.. in our study patients were analyzed with respect to the cause, presentation, diagnostic methods, treatment and mortality. Results: Most of the patients in our study were in the age group of 21-40 years. with an M:F ratio of 8:1. Motor vehicle accident (86%) was the most common mechanism of injury. Spleen injury was associated with rib fracture in 22%. There was one Mortality. Failure of NOMSI was defined as the need for operation due to ongoing bleeding from the spleen in patients initially managed nonoperatively. Failure rate of non operative management was only 16% without any mortality. Conclusions: Non-operative management in blunt abdominal trauma management is challenging owing to the diversity of presentation and wide range of visceral injuries. However, it is quite satisfying to manage them by conservative approach which is highly successful in selective cases.

Keywords: Blunt abdominal trauma, splenic trauma, computed tomographic scan, resuscitation, non operative management.