A Clinical and Hematological Analysis of the Traumatic Splenectomy

ABSTRACT

PURPOSE: The spleen is the organ most frequently injured by abdominal trauma; often by penetrating wounds to the left lower chest, flank and upper abdomen. A total splenectomy is considered the standard method of treating a splenic injury in the case of multiple organ injuries, a hemodynamically unstable condition and severe splenic injury. During the 5 years, between May 2001 and October 2005 55 splenectomy cases were performed at our clinic. This study was carried out to evaluate the clinical and hematological analysis of a splenectomy undertaken due to trauma (39 cases), with the exception of hematological diseases (16 cases). METHODS: We analyzed the clinical manifestations, intraabdominal blood loss, the total amount of transfusion, postoperative complications, and the distribution of platelet counts after a splenectomy, average time to reach maximal platelet counts and return normal platelet counts, and the periods of aspirin medication in 39 traumatic splenectomy cases. RESULTS: The male to female ratio was 2.3 1, with the most frequently injured age group being those in their third decade. The most common cause of injury was traffic accident (76.9%). There were 24 (61.5%) cases of associated injury, with the most frequents associated injury being a rib fracture (17 cases). The most common type of splenic injury was Type IV (59%). The average amount of intraabdominal blood loss and amount of transfused blood were 1,850 and 2,700 ml, respectively. The postoperative complication rate was 33.3% (13 cases), with pulmonary complications the most common (8 cases). Thrombocytosis occurred in 33 case 84.6%. After a splenectomy, the first increasing platelet count was noted after an average of 6.7+/-2.0 days, with the maximal count reached after an average of 10.8+/-2.8 days. The platelet count gradually returned to normal levels after an average of 36.1+/-20.0 days. Aspirin was medicated from a minimum of 9 to a maximum of 39 days, with an average of 23.3 days. CONCLUSION: Men in thier twenties were the most commonly injured group. Grade IV splenic injuries were the most common type requiring surgery. The average time to reach postoperative maximal platelet counts was 10.8 days. The patients where the platelet count increased above 750,000/ mm3 were treated with aspirin; there were no complications. Therefore, it is advisable to start patients on aspirin medication of aspirin, and follow up thier needs as out-patients with regular CBC workups.