Publication:

Hospital based study of non-operative management of blunt splenic trauma

Background Operative management by Splenectomy was the standard of care for blunt splenic trauma till recent years. This was based on the assumption that spleen has limited physiological role in adulthood and conservative management has a very high likelihood of potentially fatal haemorrhagic crisis.

Methods This observational descriptive study was conducted during November 2013 to November 2015 at Department of Surgery, Government Medical College and Hospital, Aurangabad, Maharashtra, India. All patients diagnosed to have splenic injury due to blunt trauma, attending casualty or OPD or referred from other centers to our tertiary centre were included in the study.

Results In our study of 32 cases, 25 (78.12%) patients underwent non operative management while 7 (21.87%) patients had splenectomy. 66.66% of children were managed conservatively, while 80.76 % of adults were managed by conservative management. 87.5% patients having systolic blood pressure 100 had splenectomy. In 18 patients, there was no abdominal distension noticed and all of them underwent conservative management. 2 patients out of 8 patients with abdominal distension up to 2 cm underwent operative management. In 6 patients abdominal distension was noticed to be > 2 cm, among which 5 patients underwent operative management. In case of non-operative management, 22 patients out of 25 patients were discharged within 10 days, while in operative management 5 patients out of 7 patients were discharged after 10 days. Mean hospital stay in non-operative management was 6.88±5.34 days, while in operative management it was 13±3.3 days. In our follow up for post non operative management complications, 19 patients of 25 patients underwent CT scan at regular intervals; none of them had any complication.

Conclusions Systolic blood pressure and abdominal distension are important parameters for deciding the management, according to our findings. Non operative management was done in majority of blunt splenic trauma cases which reduced the hospital stay. There were no serious complications noted in cases managed conservatively in our study population.