Inês Sousa (Leiria / PT), Miguel Neves (Leiria / PT), Marisa Ferreira (Leiria / PT), Alexandra Rocha (Leiria / PT), Rita Banza (Leiria / PT), Nuno Rama (Leiria / PT), Miguel Coelho dos Santos (Leiria / PT)
Abstract text (incl. references and figure legends)
Introduction: The spleen is one of the most commonly injured intra-abdominal organs in trauma patients. The priority for patients with splenic injury is to diagnose and promptly treat potentially life-threatening bleeding, so that emergency splenectomy remains a life-saving procedure.
Material & Methods: Single-center, cohort retrospective study including 22 trauma patients with splenic injuries who underwent surgery in a non-trauma center, from 2016 to 2020. The mechanism of injury, associated lesions, operative details and post-operative complications were analyzed.
Results: Twenty-two patients (20 men) were included, with a median age of 48 years. The splenic injury occurred following blunt trauma due to motor vehicle collisions (in 12 patients) or falls (in 10 patients). Most of the patients had other associated lesions (86%), such as thoracic trauma. An emergent surgical approach was performed in 15 patients, whereas 7 patients remained under surveillance, with surgery being proposed due to hemodynamic instability or a drop in hemoglobin levels. 64% of the patients had grade IV or V splenic rupture. Splenectomy was performed in 20 patients, and the spleen was preserved in 2 patients. In 3 patients other procedures were performed along with splenectomy. The median postoperative time was 16 days and 11 patients had some kind of complications, most of which Clavien-dindo II. Five patients died during hospitalization.
Conclusions: Spleen trauma can be a surgical emergency in blunt trauma patients and splenectomy is a procedure that should be performed when there is a life-threatening hemorrhage. Other associated injuries are common occurrences and should be considered and managed properly in trauma patients.
References: Coccolini, F., et al: Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg 12, 40 (2017). Maung A., Kaplan L.: Surgical management of splenic injury in the adult trauma patient. Uptodate.
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