Management of Blunt Trauma to the Spleen (Part 1)

• Main Author: Seyed Abbas Banani
• Format: Article
• Language: English
• Published: Shiraz University of Medical Sciences 2010-06-01
• Series: Iranian Journal of Medical Sciences
• Subjects: Trauma; spleen; autograft; Infection; nonoperative management
• Online Access: http://ijms.sums.ac.ir/files/PDFfiles/35_2_01-Dr.%20Banani.pdf931894956.pdf

AbstractSpleen is the most frequent solid organ to be injured in bluntabdominal trauma. Considering its important role in providingimmunity and preventing infection by a variety of mechanisms,every attempt should be made, if possible, to salvagethe traumatized spleen at any age particularly in children. Afterprimary resuscitation, mandatory requirements for nonoperativemanagement include absence of homodynamic instability,lack of associated major organ injury, admission inthe intensive care unit for high-grade splenic injury and in theward for milder types with close monitoring. About two thirdof the patients would respond to non-operative management.In most patients, failure of non-operative measures usuallyoccur within 12 hours of management. Determinant role ofabdominal sonography or computed tomography, and in selectedcases, diagnostic peritoneal lavage, for appropriate decisioncannot be overemphasized. However, the high status ofclinical judgment would not be replaced by any paraclinicalinvestigations. When operation is unavoidable, if possible,spleen saving procedures (splenorrhaphy or partial splenectomy)should be tried. In case of total splenectomy, autotransplantation,preferably in the omental pouch, may lead toreturn of immunity, at least partially, to prevent or reduce thechance of subsequent infection. Although total splenectomywith autograft is immunologically superior to total splenectomy-only procedure, these patients should also be protectedby vaccination and daily antibiotic for certain period of time.The essential steps for prevention of overwhelming infectionafter total splenectomy are not only immunization and administrationof daily antibiotic (up to 5 years of age or one year inolder children), but include education and information aboutthis dangerous complication. When non-operative managementis successful, the duration of activity restriction (inweeks) is almost equal to the grade of splenic injury plus 2.Iran J Med Sci 2010; 35(2): 79-94.