| Abstract [eng] |
Objective The objective of our study was to determine the main causes of blunt splenic injuries and their distribution by age, sex and splenic injury grade; to evaluate the operative and conservative management methods applied, to compare the lengh of hospital stay and complications. Methods The records of 154 patients admitted to the Vilnius University Emergency Hospital with blunt splenic injuries in the period from 01 01 1996 to 31 12 2005 were retrospectively analysed. Results During the study period, 113 men and 41 women were admitted to our hospital with blunt splenic injury. In 108 (70%) cases isolated splenic injury was found and concomitant (often multiple or polytrauma) trauma was dignosed in 46 (30%) patients. The main causes of splenic traumas were: traffic accidents 34%, assault 29%, falling down 10%, falling from height 8%, other or unknown causes 8%. 11% of patiens denied traumas. The mean age of men was 34.2 and of women 39.7 years. The distribution by splenic injury grade was: I° – 11%, II° – 22%, III° – 40%, IV° – 18%, V° – 9%. In all 46 polytrauma cases, operative management was applied, splenectomy was performed. The average hospital stay was 21.4 days. 14 (30%) of these patients died in the early post-traumatic period due to heavy concomitant injuries. In the case of isolated splenic injury (n - 108), 96 (89%) patients were operated on: 90 splenectomies and 6 splenorrhaphies were performed. The mean hospital stay of 9.9 days was noted for this group. One patient died in the late postoperative period after subphrenic abscess formation and sepsis. In 12 (11%) cases nonoperative management was applied. The mean hospital stay was 9.6 days. One of these patients was operated on after 4 months due to splenic cyst formation; splenectomy was performed. No other complications after conservative management were noted. Conclusions The main causes of blunt splenic injuries were traffic accidents and assault. Blunt splenic trauma was more common in males. Blunt splenic trauma was most frequent among middle-aged population. Multiple organ injuries and the associated high mortality were present in 30% of cases. In the case of operative treatment of isolated splenic injury, splenic salvage should be preferred. Twelve patients with isolated blunt splenic injuries were successfully treated nonoperatively. Criteria of patient selection for nonoperative treatment and the treatment algorithms should be accepted for a wider usage of this method of management. |
