Splenic trauma: The reality of Centro Hospitalar de Trás-os-Montes e Alto Douro in the last 13 years

Introduction: Splenic injuries are among the most common in situations of abdominal trauma in adults. Early diagnosis can reduce associated mortality.

Material & Methods: A retrospective study was performed at CHTMAD including all cases of splenic trauma in adults between January 2010 and January 2023. The objective of the study was to evaluate the mechanism, pattern of injuries, treatment and associated mortality.

Results: The majority of splenic injuries occurred in men aged between 20 and 90 years (median 53 years). Road accidents were the main cause of injuries and the most common injury mechanism was blunt abdominal trauma. Splenic injuries were classified, using CT, according to AAST (American Association for the Surgery of Trauma) into 5 grades, with grades III and IV being the most prevalent and with other associated intra-abdominal injuries. Hemodynamic instability and the need for blood transfusion occurred more frequently in patients with grade III and IV injuries.The majority of splenic injuries were severe, but with hemodynamic stability upon admission, so conservative treatment was performed and splenectomy was deferred in less than 7% of cases. Urgency splenectomy was performed in the majority of cases. Associated mortality was less than 10% of cases in grade IV injuries associated with other intra-abdominal injuries.

Conclusions: The decision regarding the best approach to splenic trauma is based on the patient's clinical presentation, the surgeon's experience, as well as radiological findings, when possible.

References: Larsen J. , Thorsen K. Splenic injury from blunt trauma. British Journal Surgery, 2023 Aug 11;110(9):1035-1038; Petrone P., Pena M., Staffolani M., Evolution of the treatment of splenic injuries: from surgery to non-operative management, Spanish Journal Surgery 2017 Oct;95(8):420-427

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