NON-OPERATIVE MANAGEMENT OF BLUNT HEPATIC AND/OR SPLENIC TRAUMA: A PROSPECTIVE STUDY
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2015, Vol 4, Issue 21
Abstract
[b] PURPOSE[/b]: The incidence of blunt splenic and hepatic injuries are on a rise not only because of an increase in the overall incidence of Road Traffic Accidents but also due to more liberal use of radiological tests in the work-up of these patients. Spleen and liver are respectively the first and the second most common intra-abdominal organs to be injured in blunt abdominal injury. However, most of these patients can be treated without a formal laparotomy and its associated complications, as long as they remain hemodynamically stable. Although few studies have proven the efficacy of conservative management, most of them are retrospective. This prospective study aims to evaluate the efficacy of conservative management of blunt liver and/or splenic injuries.[b] MATERIALS [/b] [b]AND METHODS:[/b] Over a 12-month period, a total of 56 patients with blunt hepatic and/or splenic injury were evaluated prospectively. Fourteen [25%] patients underwent immediate exploration for hemodynamic instability and the rest 42 patients constituted the study group. Injury Severity Score [ISS] was used to assess the extent of overall injury. Unstable patients underwent emergent laparotomies, and stable patients had abdominal computed tomography (CT) scans to grade the source and severity of their injury. Hepatic and splenic injuries were graded using AAST grading for solid organ injuries. Those with nonhepatic, nonsplenic operative indications underwent exploration, and the remaining patients were intentionally managed nonoperatively in the trauma intensive care unit. Frequent measurement of vitals and estimation of hemoglobin and hematocrit was done. The outcome was measured in terms of total blood transfused, total duration of hospital stay and complications due to conservative management. [b]RESULTS[/b]: A total of 56 patients presented to our ED with blunt abdominal trauma. Fourteen patients had to undergo emergent surgery for hemodynamic stability. The rest 42 were intentionally managed without surgery. In our study, Spleen was the most commonly injured organ and accounted for about 78% of all patients. In 5.1% patients, both splenic and hepatic injury was observed. The mean age of the group was 31 years with approximately 80% of all patients being males. Road traffic accidents were the most common mode of injury overall [78.5%] but in women, assault with a blunt weapon was more common. Conservative management was successful in 87.8% of all blunt splenic injuries and 100% of blunt hepatic injuries. Three patients [7.1%] needed delayed laparotomies and failed conservative management. All 3 patients had AAST Grade IV splenic injury. Two patients [4.7%] were diagnosed to have biliary leaks without bilioma formation. Both leaks resolved completely after they were percutaneously aspirated. Conservative management was associated with decreased blood transfusion requirement, lesser duration of stay in the hospital and was associated with minimal complications, all of which were successfully managed without surgery. Patients with AAST grade IV splenic injury, massive hemoperitoneum and increased transfusion requirements were associated with a higher risk of failing conservative management. Initial pulse rate, systolic blood pressure, ISS and hemoglobin did not appear to influence the outcome of the study. There were no deaths reported in the study. [b]CONCLUSION[/b]: Conservative DOI: 10.14260/jemds/2015/530 [b]ORIGINAL ARTICLE[/b]J of Evolution of Med and Dent Sci/ eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 4/ Issue 21/ Mar 12, 2015 Page 3683management of blunt hepatic and/or splenic injury is safe and effective as long as patients are selected based on strict inclusion/exclusion criteria. AAST grade IV splenic injury or higher, massive hemoperitoneum, requirement of >3.5 units of blood and new-onset hemodynamic instability were independent predictors of failure of conservative management.
Authors and Affiliations
Ravikar Jairaj, Tejaswi Shashikanth , Harindranath H. R, Vinayak Chavan
Keywords
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- EP ID EP153734
- DOI 10.14260/jemds/2015/530
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