Spleen injury - evaluation of group of patients with splenic injury for 6 years
Authors:
Ondřej Strnadel; Tomáš Mrázek
Authors place of work:
Department of surgery and traumatology, Ostrava citi hospital
; Oddělení chirurgie a úrazové chirurgie, Městská nemocnice Ostrava
Published in the journal:
Úraz chir. 24., 2016, č.4
Summary
Introduction:
Spleen trauma is the most usuall cause of haemoperitoneum in the blunt abdominal injury. It is not only part of polytrauma when treating patients in specialized traumacentre, but it is also part of treatment of isolated trauma in usuall surgery departement.
Materials and methods:
Our aim is to evaluate and to present results of treating Spleen trauma in our departement. Evaluation of Spleen trauma cases treated on our departement between 1/2010 and 12/2015. The subject of evaluation was the demographic data, cause of injury, treatment strategies, the degree of injury to the spleen, presence of haemoperitoneum at income examination at haemodynamical stability. We excluded patients with iatrogenal Spleen bleading by nontrauma surgery of abdomen. Angioembolisation was not used due to the unavailability of an interventional radiologist at our hospital.
Results:
The group consisted of 32 patients with a mean age of 40 years, 25 men and 7 women. The average degree of injury to the spleen according AAST was 2.78. With one exception it was a blunt injuries. Acute laparotomy was indicated in 20 cases by 3th and 4th degree of blunt injury and 2nd degree of penetrating injury. In all cases marks of haemoperitoneum at CT examination and hemodynamical instability was present. In 6 cases spleen savage procedure was performed. In 1st and 2nd degree of Spleen injury (11 patients) no hemodynamical instability was present at the time of admitting. Nonoperative treatment was succesfull in 7 cases, 4 times progression of haemoperitoneum lead to splenectomy in nonacute phase, once laparoscopical haemostasis in case of hemodynamical stable patient was performed and once laparotomy and haemostasis in case of penetrating injury.
Conclusion:
Treating patient with Spleen injury require individual approach with exact assesment of the overall condition of patient. With improvements of surgery techniques, laparoscopical methods, radiodiagnostic and intensive care is at first place conservative treatment and spleen savage procedure. Splenectomy has its place as a life-saving procedure at severe abdominal trauma with hemodynamical instability.
Keywords:
Splenectomy, haemoperitoneum, spleen injury
Zdroje
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