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Nonoperative management of blunt and penetrating splenic traumas

Keywords: Splenic trauma , blunt , penetrating , nonoperative approach

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Abstract:

Aim: Current management for splenic trauma had been shifted towards conservative approaches with nonoperative therapy. In this retrospective study, splenic trauma cases managed nonoperatively in our clinic for the last three years have been evaluated and the advantages of nonoperative approach have been discussed. Material and Methods: Twenty-one splenic trauma cases admitted to our Emergency Room between July 2003 and September 2005 were evaluated retrospectively. Results: Female to male ratio was 7/14 with a mean age of 27.57±2.34 (13-53). The etiologies of the trauma type were falls from a height in 7 cases, penetrating stab wound in 6 cases, pedestrians struck in 6 cases, motor vehicle collision in 1 case and assault in another. Abdominal ultrasonography and computerized tomography were performed to all cases before hospitalization. During the hospitalization period serial abdominal examinations and serial hemoglobin follow up were performed under strict bed rest. Grades of injuries according to the American Trauma Association Organ Injury score were Grade I in 8 cases, Grade II in 9 cases, Grade III in, 3 cases, and Grade IV in 4 cases. Nonoperative management was performed to 17 cases (81%) whereas 4 cases (19%) were operated for hemodynamic instability. Mean hospital stay was 6.52 ± 0.75 (2-15) days. The only mortality occured in a case with injury due to motor vehicle collision operated for multitrauma (4.76%). All of the remaining cases were discharged from the hospital without any problem. Conclusion: Hemodynamically stable splenic trauma cases especially with Grade I, II, III injuries can safely be managed by nonoperative approach and unnecessary splenectomies can be avoided.

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