Blunt splenic rupture--experience in a preserving non-operatively orientated care team in a tropical hospital.

OBJECTIVES: With a view to the prevention of immediate and later complications of splenectomy, especially the risk of overwhelming post-splenectomy sepsis syndrome (OPSS), conservative treatments have been proposed when the haemodynamic condition of the patient permits this. In this study, we present our experience in a preserving non-operatively orientated care team in a tropical hospital. PATIENTS AND METHODS: Twenty patients admitted to Hoima Hospital, Hoima, Uganda with splenic injuries from blunt abdominal trauma between July and December 1995 were included in the study. For every patient, serial monitoring of clinical and haematological data was done. Ultrasonography was used to give an accurate assessment of the severity of splenic and concomitant injuries. In stable patients a conservative approach was adopted. RESULTS: In our study 15 patients were managed non-operatively, while 5 underwent splenectomy. Grades I, II, and IIIa spleen injury was significantly associated with non-operative treatment, while grade V was associated with splenectomy (Student-Newman-Keuls test P < 0.05, Mantel-Haenszel chi-square for trend chi 2 = 8.7, P = 0.003). Comparing the non-operative and laparotomy groups, the length of hospital stay (14.0 v. 12.8 days) was similar (t = 1.71, df 18, P > 0.05), while the average blood transfusion volume given was 1.1 units and 3.0 units respectively (t = 3.58, df 18, P < 0.005). CONCLUSIONS: The present study confirms the ability to preserve an increasing number of traumatised spleens by non-operative therapy. This has become possible as a consequence of increasing experience and confidence in pursuing a non-operative approach based on accurate diagnostic methods. Furthermore, non-operative management does not increase the length of stay in hospital and it reduces the total volume of blood transfusions required. While we agree with others that the choice between operative and non-operative management of splenic trauma should be based mainly on clinical grounds, ultrasonography and peritoneal lavage were important tools in the diagnostic pathway and in decision-making. It is worth noting that a 'safe' grade of spleen injury does not exist, since even minor lesions can lead to massive haemoperitoneum and shock requiring emergency splenectomy. In view of the now well known early and late complications after splenectomy, spleen preservation should be the treatment of choice for splenic trauma, especially in tropical countries.