Non-operative Management for Penetrating Splenic Trauma: How Far Can We Go to Save Splenic Function?

Overview

Journal World J Emerg Surg

Publisher Biomed Central

Specialty General Surgery

Date 2017 Aug 4

PMID 28769999

Citations 6

Authors

Roy Spijkerman

Michel Paul Johan Teuben

Fatima Hoosain

Liezel Phyllis Taylor

Timothy Craig Hardcastle

Taco Johan Blokhuis

Brian Leigh Warren

Luke Petrus Hendrikus Leenen

Affiliations

Soon will be listed here.

Abstract

Background: Selective non-operative management (NOM) for the treatment of blunt splenic trauma is safe. Currently, the feasibility of selective NOM for penetrating splenic injury (PSI) is unclear. Unfortunately, little is known about the success rate of spleen-preserving surgical procedures. The aim of this study was to investigate the outcome of selective NOM for penetrating splenic injuries.

Methods: A dual-centre study is performed in two level-one trauma centres. All identified patients treated for PSI were identified. Patients were grouped based on the treatment they received. Group one consisted of splenectomised patients, the second group included patients treated by a spleen-preserving surgical intervention, and group three included those patients who were treated by NOM.

Results: A total of 118 patients with a median age of 27 and a median ISS of 25 (interquartile range (IQR) 16-34) were included. Ninety-six patients required operative intervention, of whom 45 underwent a total splenectomy and 51 underwent spleen-preserving surgical procedures. Furthermore, 22 patients (12 stab wounds and 10 gunshot wounds) were treated by NOM. There were several anticipated significant differences in the baseline encountered. The median hospitalization time was 8 (5-12) days, with no significant differences between the groups. The splenectomy group had significantly more intensive care unit (ICU) days (2(0-6) vs. 0(0-1)) and ventilation days (1(0-3) vs. 0(0-0)) compared to the NOM group. Mortality was only noted in the splenectomy group.

Conclusions: Spleen-preserving surgical therapy for PSI is a feasible treatment modality and is not associated with increased mortality. Moreover, a select group of patients can be treated without any surgical intervention at all.

Citing Articles

Outcomes of selective non-operative management in adults with abdominal gunshot wounds: a systematic review and meta-analysis.

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Conservative Management of Splenic Injury in Blunt Abdominal Trauma: A Single Center Experience.

Osman M, Alam M, Iftikhar M, Khan A Cureus. 2023; 15(8):e43014.

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Outcomes of patients with thoraco-abdominal gunshot wounds operatively managed at a district hospital in Cape Town, South Africa.

Klopper J, Moola H, Venter J, Cheddie D, Luzulane S, Muchenje T Afr J Emerg Med. 2021; 11(1):60-64.

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Predictors of surgical management of high grade blunt splenic injuries in adult trauma patients: a 5-year retrospective cohort study from an academic level I trauma center.

Nijdam T, Spijkerman R, Hesselink L, Leenen L, Hietbrink F Patient Saf Surg. 2020; 14:32.

PMID: 32774457 PMC: 7398213. DOI: 10.1186/s13037-020-00257-3.

Non-operative management of blunt splenic injury: is it really so extensively feasible? a critical appraisal of a single-center experience.

Fransvea P, Costa G, Massa G, Frezza B, Mercantini P, BaIducci G Pan Afr Med J. 2019; 32:52.

PMID: 31143357 PMC: 6522183. DOI: 10.11604/pamj.2019.32.52.15022.

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