Abstract

Dr. Rijumani Das, Dr. Jnandeep Sarma, *Dr. Hussain Ahmed, Dr. Partha Pratim Das

ABSTRACT

Introduction: The spleen is a lymphoreticular organ situated in upper left quadrant of the abdomen which is extremely friable and highly vascular organ, and very prone to injury during trauma to abdomen (both blunt and penetrating, although more common in blunt trauma). Splenic trauma is most commonly seen to occur following motor vehicle accidents (RTA), though it can also result following falls, sport related activities or assault. Materials and Methods: During the period of study from 1st June 2018 to 31st May 2019, 50 patients with splenic trauma admitted in Department of Surgery, GMCH were taken up for the purpose of study. Appropriate investigations like hematological investigations, X-ray chest and abdomen, ultrasonography, CT scan and angiography were done as required in those cases of splenic injury. Either non-operative or operative management was done in these cases depending upon the situation. Results and Observations: Our study population comprised 50 patients of splenic injury following blunt trauma out of which 46 patients were male (92%) and 4 patients were female (8%) with a ratio of 11.5:1. Majority of the cases were observed in second and third decade of life and the most common cause was found to be motor vehicle accidents (60%). 28 patients (56%) presented with mild to severe pain abdomen, 14 patients (28%) with distension of abdomen, 10 patients (20%) with dyspnoea, 5 patients (10%) with vomiting and 4 patients (8%) with oliguria. Physical findings on abdominal examination in order of frequency were tenderness in 27 cases (54%), abdominal distension in 14 patients (28 %), tenderness in chest in 14 patients (28%), shock in 5 patients (10%), rigidity in 6 cases (12%), absent bowel sound in 2 patients (4%) and pallor in 8 patients (16%). Out of 50 patients with splenic injury, 12 patients (24%) had associated chest injury, 10 patients (20 %) had renal injury, 10 patients (20 %) had hepatic injury, 5 patients (10%) had head injury and 4 patients (8%) had bowel injury. Most of the patients, i.e., 5 in numbers were operated within 7-12 hours of presentation to hospital (28.56 %). All the operative procedure were splenectomy. Conclusion: It has been found that splenic injury is very common following road traffic accidents, that too, among the male population between the age of 15-25 years. Careful physical examination is the key factor in early diagnosis. Investigation reports are complementary to physical findings. Great number of patients, except a few, sustaining blunt abdominal injury can be saved, provided they reach the hospital early. Early hospitalization, better methods of diagnosis, proper timely surgical intervention, availability of blood transfusion, close clinical observation and nursing care are have allowed reliable identification of variables that can guide the surgeon either to immediate laparotomy, angiography, or a non-operative course.