Climical Study of Isolated Splenic Trauma -Our Experience at Gmkmch,Salem.

IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 18, Issue 10 Ser.4 (October. 2019), PP 20-22 www.iosrjournals.org Climical Study of Isolated Splenic Trauma – Our Experience at Gmkmch,Salem. 1 Prof Dr.K.Kesavalingam1 M.S., Dr.V.Sri Priyadharsan 2 (Professor Of General Surgery, Government Mohan Kumaramangalam Medical College ,Salem,Tamilnadu,India) 2 (Post Graduate ,Department Of General Surgery,Government Mohan Kumaramangalam Medical College,Salem,Tamilnadu,India) Corresponding Author: Dr.V.Sri Priyadharsan , Post Graduate Abstract: Introduction: Splenic Trauma Is The Most Common Organ Inivolved In Blunt Injury Abdomen. Among Which Road Traffic Accidents AcountsThe Most Of The Cases. Background & Aim: The Aim Of Our Study To Evaluate The Morbidity, Moratality& Management Of Isolated Splenic Trauma.It Account For About 8% Of All Traumatic Admissions And 40-60 % With Significant Blunt Splenic Injury. Materials &Methods:A Prospective Study Of 50 Patients With Isolated Low And Moderate Grade ( 1 To 4) Blunt Splenic Trauma Admitted In Our Trauma Ward, Gmkmch,Salem. During The Period Of 1 Year From August 2018 To August 2019. Observation: Out Of 50 Patients , 35 Were Treated Conservatively, Monitored Serialy And Discharged And 5 Patients With Unstable Hemodynamic Was Operated. Conclusion : Non Operative Management Was Prefered Management For Hemodynamically Stable Patient With Less Morbidity And Mortality. Keywords: Blunt Splenic Injury, Road Traffic Accident, Grade Of Injury Introduction: Inspite Of Its Position Under Rib Cage, Spleen Remain The Most Common Organ Involved In The Blunt Injury Abdomen. In Which Road Traffic Accidents Remain Major Mode Of Injury.Recent Advance In The Radiological Tecniques Makes Shift Towards Non Operative Management Of The Spleenic Trauma. The Present Study Evaluates The Outcomes Of Isolated Low To Moderate Grade Splenic Trauma Mangement At Gmkmch, Salem. ----------------------------------------------------------------------------------------------------------------------------- ---------Date of Submission: 21-09-2019 Date of Acceptance: 10-10-2019 ----------------------------------------------------------------------------------------------------------------------------- ---------- I. Aim and Objectives Aim of Our Study Is To Evaluate the Outcome Of Isolated Low And Moderate Grade Splenic Trauma At Gmkmch, Salem II. Material and methods: Study design - prospective non randomised study Study group – Over a period of 1 year, 50 patients with low and moderate grade (I-IV) isolated blunt splenic trauma admitted in trauma ward at GMKMCH, Salem were enrolled in our study Inclusion criteria:  Male and female with isolated blunt splenic trauma  Age between 20 – 70 years  Hemodynamically stable patients  Patient giving consent for study Exclusion criteria:  Patients associated with other injuries like spleen,bowel,etc.,  Patient with co morbidities  Hemodynamically unstable patients  Patient not willing to give consent DOI: 10.9790/0853-1810042022 www.iosrjournals.org 20 | Page Climical Study of Isolated Splenic Trauma – Our Experience at Gmkmch,Salem. Study method instituted: From August 2018 to August 2019 a study was conducted to know the outcome of non operative management of blunt splenic trauma among patients admitted in surgical trauma ward in GMKMCH, Salem. All patients were serially monitored by the trauma care team. History reagarding the mode of injury, hemodynamic status of the patients were monitored serially. Patients with low and moderate grade splenic trauma with hemodynamically stable patients were treated as non operative management. Pateints grouped according to the CT GRADING of injury. Patients were treated in ICU with serial monitoring of haemoglobin, blood pressure, pulse rate, urine output, respiratory rate , saturation, abdominal girth. Any deterioration in above mentioned parameters were monitored and managed accordingly.patients were followed till the date of discharge. III. Results and Discussion Among 50 patients with low and moderate grade isolated splenic injury . Nature of injury, demographics, grade of splenic injury, number of blood transfusion, duration of hospital stay, morbidity and mortality among them were monitored and analysed. Table 1: Mode of injury: MODE OF INJURY Road Traffic Accident Self Fall Fall From Height Assault NO OF PATIENTS 28 15 5 2 PERCENTAGE 56% 30% 10% 4% In our study majority of patients 56% of had blunt splenic trauma due to road traffic accidents, followed by self fall accounts 30% , fall from height 10% and assault 4%. Table 2: Sex Incidence: Female cases no of cases 14 Male cases no of cases 36 percentage 28 percentage 72 72 % of people in our study is males. 28% were females. Table 3: Age Incidence: Age group 21-30 31-40 41-50 51-60 61-70 No of cases 18 16 9 4 3 Percentage 36 32 18 8 6 Table 4: Grade Of splenic Injury: Grade of splenic injury I II III IV No of patients 11 18 15 6 Percentage 22.5 35 30 12.5 Grade II splenic injury is commonest, followed by grade I, grade III & grade IV. I & II were considered as low grade. III & IV were considered as moderated grade. Table 5: Number Of Blood Products Received: Grade of liver injury I II III IV No of blood products recieved 0 +/- 1 0 +/- 1 1+/-1 2+-1 Low grade injuries rarely needs blood transfusion. Moderate injury needs blood transfusion based on the hemodynamic status. Table 6: Management: Grade of liver injury I II III IV Non operative management no of cases percentage 11 100% 18 100% 13 87% 2 33% DOI: 10.9790/0853-1810042022 Operative management no of cases percentage Nil -Nil -2 13% 4 67% www.iosrjournals.org 21 | Page Climical Study of Isolated Splenic Trauma – Our Experience at Gmkmch,Salem.    In our study out of 50 patients, 29 patients – 60% of patients were hemodynamically stable and managed conservatively. About 30% - 15 patients presents with hemodynamic instability, managed with blood transfusion, I v fluids without any increase in morbidity.. About 6 patients presents with profound shock, prolonged need of blood transfusion, hemodynamically instable, hence planned for emeregency operative management. Table 7: Length of hospital stay: Grade of liver injury I II III IV Length of hospital stay 7+/-2 days 7+/- 3 days 12+/-2days 14 +/- 4days Average length of stay for grade I & II splenic trauma was 7 to 10 days, grade III& IV splenic trauma was 10 to 14 days. IV. Conclusion Non operative management remain main stay for low grade and hemodynamicallystabe moderate injury cases. In patients profound hemodynamic instability operative management remains main mode of treatment. References [1]. [2]. [3]. Shackford SR, sise MJ, virigilio, petersRM.selective management of blunt splenic trauma. J trauma1986;26:970-9. Andersson R, AlwmarkA,Gullstrand P, Offenbarti K, Bengmark S.(1986) Non operative treatment of blunt trauma to liver and spleen. ActaChirScand 152:739-741. ellis BW, Paterson –brown S.Hamilton bailey’s emergency surgery. 13 th ed. Ch22. London:Arnold;1982. Ekpenyong, Nnette. “B Scan of Orbit with Its Clinico-Surgical Correlation.” IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), vol. 18, no. 10, 2019, pp 20-22. DOI: 10.9790/0853-1810042022 www.iosrjournals.org 22 | Page