Blunt splenic rupture - experience in a preserving non-operatively orientated care team in a tropical hospital

Objectives. With a view to the prevention of immediate and later complicati ons of splenectomy, especially the risk of overwhelming post-splenectomy se psis syndrome (OPSS), conservative treatments have been proposed when the h aemodynamic condition of the patient permits this. In this study, we presen t our experience in a preserving non-operatively orientated care team in a tropical hospital. Patients and methods. Twenty patients admitted to Hoima Hospital, Hoima, Ug anda with splenic injuries from blunt abdominal trauma between July and Dec ember 1995 were included in the study. For every patient, serial monitoring of clinical and haematological data was done. Ultrasonography was used to give an accurate assessment of the severity of splenic and concomitant inju ries. In stable patients a conservative approach was adopted. Results. In our study 15 patients were managed nonoperatively, while 5 unde rwent splenectomy. Grades:I, II, and IIIa spleen injury was significantly a ssociated with non-operative treatment, while grade V was associated with s plenectomy (Student-Newman-Keuls test P < 0.05, Mantel-Haenszel chi-square for trend chi(2) = 8.7, P = 0.003). Comparing the non-operative and laparot omy groups, the length of hospital stay (14.0 v. 12.8 days) was similar (t = 1.71, df 18, P> 0.05), while the average blood transfusion volume given w as 1.1 units and 3.0 units respectively (t = 3.58, df 18, P < 0.005). Conclusions. The present study confirms the ability to preserve an increasi ng number of traumatised spleens by non-operative therapy. This has become possible as a consequence of increasing experience and confidence in pursui ng a non-operative approach based on accurate diagnostic methods. Furthermo re, non-operative management does not increase the length of stay in hospit al and it reduces the total volume of blood transfusions required. While we agree with others that the choice between operative and non-operative mana gement of splenic trauma should be based mainly on clinical grounds, ultras onography and peritoneal lavage were important tools in the diagnostic path way and in decision-making. It is worth noting that a 'safe' grade of splee n injury does not exist, since even minor lesions can lead to massive haemo peritoneum and shock requiring emergency splenectomy. In view of the now we ll known early and late complications after splenectomy, spleen preservatio n should be the treatment of choice for splenic trauma, especially in tropi cal countries.