CONSERVATIVE MANAGEMENT OF ISOLATED SPLENIC INJURY IN A TERTIARY HOSPITAL

DR.S.SENTHILVEL; DR.D.CHANDRASEKARAN; DR.RENJITH.T.V; DR.M. SARAVANAN

Volume : VIII, Issue : VIII, August - 2019

CONSERVATIVE MANAGEMENT OF ISOLATED SPLENIC INJURY IN A TERTIARY HOSPITAL

Dr. S. Senthilvel, Dr. D. Chandrasekaran, Dr. Renjith. T. V, Dr. M. Saravanan

Abstract :

INRODUCTION The spleen is one of the most commonly injured intra-abdominal organs. The goal is to manage the potentially life-threatening hemorrhage. The preservation of functional splenic tissue is secondary and in selected patients it may be accomplished by using non-operative management. Conservative management is applicable to hemodynamically stable patients with spleen injuries detected by CT . Total splenectomy was regarded as the modality of treatment for splenic injuries. But, patient will be more vulnerable for infection with encapsulated organisms. Considering anatomical & physiological status, treatment modality was changed to splenic preservation. MATERIALS AND METHODS This study is a prospective type study of 50 cases of blunt trauma abdomen with splenic injuries in all wards of MGMGH, Trichy ,KAPV medical college from 2016 to 2018. Once the patient was admitted in the trauma ward, name ,age, sex ,mode of injury & admission time noted, latent period identified. After doing proper resuscitation , all patients underwent proper clinical examination . Depending upon clinical findings decision was taken for next level of management - that is for investigations , chest x ray- pa view , abdomen erect ,USG abdomen , contrast enhanced CT . Thus mode of management was decided . Patients haemoglobin levels were monitored on 3rd day & 5th day with repeat USG . Patients selected for conservative modalities were placed on strict bed rest ,serial clinical examination which include heart rate ,pulse rate ,respiratory rate, repeat abdominal examinations .Those who were operated were monitored for the cause of death . Each patients were followed up to the day of discharge & and every monthly up to 6 months . Post operative morbidity & duration of hospital stay were recorded . The above parameters were recorded in proforma prepared for this study. RESULTS Total indices- age group based study, in this study majority of the patients are in the age group of 21-30 then 31-40 (36%,34%incidence) . About 50 patients presented with abdominal pain and left hypochondrial tenderness. About 40 patients presented with abdominal distension with guarding and rigidity, and pallor. Kehr�s sign was positive only in 2 cases and that was in grade 4 and 5. Hemodynamic instability was only seen in 1 case which was a case of shattered spleen. So grade 1 presents with left hypochondrial pain with tenderness. Grade 2 & 3 presents with pallor & guarding . Khers sign was positive in grade 4&5 .Grade 5 presented with hemodynamic instability . splenic injury has a mean latent period of 16hrs to manifest. CONCLUSION: Grade one injury can present with left hypochondrial pain and tenderness. Distention and guarding can present with grade 2&3. Hemodynamic instability can observe in grade 4 & 5 . Khers sign may observe in grade 4&5. Left side hemothorax with rib fracture will be the frequent associated injuries . Upto grade 3 we can manage conservatively in our population size grade 4 & 5 incidence is too low. so we can attempt an trial but never resist to convert in operative manner if patient gong for hypovolemia . Blood transfusion is ideal in conservative management of blunt splenic injury.