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ORIGINAL ARTICLE
Year : 2017  |  Volume : 20  |  Issue : 1  |  Page : 13-15

Etiology and management of splenic injuries: The experience at Federal Teaching Hospital, Gombe, Northeast Nigeria


1 Department of Surgery, Federal Medical Center, Keffi, Nigeria
2 Department of Surgery, Federal Teaching Hospital, Gombe, Nigeria

Date of Web Publication11-Apr-2017

Correspondence Address:
A A Adejumo
P.O. Box 324, Gwagwalada, FCT-Abuja
Nigeria
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DOI: 10.4103/1118-8561.204327

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  Abstract 


Objective: To appraise the current management of splenic trauma with the available resources in our environment and re-emphasizing the role of a sound clinical judgment and early intervention. Methodology: This is a prospective cross-sectional study in which patients that sustained splenic injuries were resuscitated and optimized for laparotomy. Broad spectrum antibiotics and generous analgesia were given. Laparotomy was carried out in all patients and treatment was given according to the grade of injury sustained. Other systemic injuries were co-managed with other subspecialties. Results: Patients in the study were aged 7–52 years (male: female = 3.4:1). The modal age group was 11–20 years. All patients were managed operatively. The majority (51.5%) of splenic trauma in our study were due to vehicular accidents. There was no statistical association between sonographic and intraoperative findings (P = 0.218). Splenectomy was the most common procedure carried out. Complications encountered include surgical site infection (9, 27.3%), respiratory tract infection (6, 18.2%), and deep vein thrombosis (1, 3.0%). The duration of hospital stay for patients was 9–26 days (mean = 12.69 ± 6.30 days). Conclusion: The management of splenic injuries has evolved over the years. The role of a sound clinical judgment is crucial to a successful management outcome, especially in the third world countries.

Keywords: Management outcome, spleen, trauma


How to cite this article:
Adejumo A A, Suleiman Y H, Guduf M I. Etiology and management of splenic injuries: The experience at Federal Teaching Hospital, Gombe, Northeast Nigeria. Sahel Med J 2017;20:13-5

How to cite this URL:
Adejumo A A, Suleiman Y H, Guduf M I. Etiology and management of splenic injuries: The experience at Federal Teaching Hospital, Gombe, Northeast Nigeria. Sahel Med J [serial online] 2017 [cited 2017 Oct 23];20:13-5. Available from: http://www.smjonline.org/text.asp?2017/20/1/13/204327




  Introduction Top


The spleen is an organ bestowed with immunological and hemopoietic functions and usually the most injured organ following abdominal trauma.[1],[2],[3] Time is of the essence when managing splenic trauma to avert mortality ensuing.[4] More often than not, splenic injuries could be diagnosed on clinical grounds; however, radiological assessment, in addition, is invaluable to categorize the degree of injury with a view of triaging the patients that will benefit from nonoperative management.[4],[5] We should not be unaware of uneven distribution of health resources in our environment and as such, early diagnosis and intervention based on the clinical grounds is paramount to achieving a good outcome. In this study, we decided to look at the common etiology, presentation, and management outcome of splenic trauma in the study center.


  Methodology Top


This is a prospective cross-sectional study carried out over a 36-month period (January 2012 to December 2014), on patients that presented with blunt or penetrating abdominal injury, to the emergency unit of the Federal Teaching Hospital, Gombe. Patients who presented with an abdominal injury, who met the indication for laparotomy, in whom an intraoperative finding of splenic injury was made, were studied. Initial care followed the advanced trauma life support course protocol, with analgesia, antitetanus, and antibiotics as indicated. Investigations were carried out as appropriate. The main diagnostic investigation was abdominal ultrasound (Focused Assessment with Sonography in Trauma) although other ancillary investigations such as X-rays and hematological tests were also done. Indications for laparotomy in blunt trauma included findings of peritonitis, shock, or positive findings on the investigation. In addition, evisceration in penetrating trauma mandated exploration. We also adopted a policy of mandatory exploration for all high-velocity gunshot wounds to the abdomen. Postoperative care was routine, and patients were followed up until discharge and for three subsequent follow-up visits. Information was gathered from the patient's case file as well as operative notes. All information so gathered was entered into a pro forma and subsequently analyzed using EpiInfo statistical software which was developed by the centers for diseases control and prevention (CDC), Baltimore, Maryland, USA. Quantitative data were presented in frequencies and percentages, mean and standard deviations were calculated.


  Results Top


There was a total of 33 patients seen over the 3 years period. There were 24 (72.3%) males and 9 (27.3%) females giving a male to female ratio of 3.4:1. Their ages ranged from 7 to 52 years with a mean of 26.10 ± 12.64 years. The majority (42.4%) of the patients were aged 11–20 years. Presentation-intervention interval was 5.13 ± 3.55 h. The etiology of injury as well as the grades of injuries encountered are as shown in [Table 1]. [Table 2] illustrates the grades of injuries encountered according to the American Association for the Surgery of Trauma-Organ Injury Scale for spleen. [Table 2] also shows the correlation between the preoperative (sonographic) findings and the intraoperative (clinical) findings. This did not show any significant statistical association (P = 0.218). The most common procedure done was splenectomy and colostomy in 9 (27.3%) patients. [Table 3] shows the various procedures carried out on the patients, associated organ/systems involved in the injuries as well as the complications that ensued during the course of management. The duration of hospital stay for these patients ranged between 9 and 26 days with a mean of 12.69 ± 6.30 days.
Table 1: Demographic and clinical parameters of patients

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Table 2: Degree of accuracy between sonographic and clinical findings

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Table 3: Procedures done and various outcome measures

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  Discussion Top


The occurrence of splenic injuries has been described in many literatures and the younger age groups are most vulnerable. In our study, more than half of our patients were in the second and third decades of life, and this agrees with the findings of other authors.[6],[7] More males were involved than females, and this is in keeping with the overall male preponderance in trauma generally. Other workers from this region have reported a similar trend as well.[7],[8]

Our attempts at the preoperative grading of splenic injury using abdominal ultrasound showed a wide discordance with intraoperative findings. This is in keeping with the findings of other workers from Ibadan, Southwest Nigeria.[9] Ultrasound is known to be highly operator dependent, and in our study, compounded by the fact that different sonologist scanned different patients at different times, therefore, making uniformity difficult to achieve.

Total splenectomy was the most frequent procedure carried out on our patients in this study. This is consistent with reports of other authors who affirmed that splenectomy was the most frequent procedure done for splenic trauma.[10],[11] Splenectomy in this study was carried out on patients with Grade IV and V injuries as well as those with low-moderate grade caused by high-velocity missiles, associated head injuries, and/or fecal peritoneal contamination from bowel injury. All our patients had open surgeries, and splenic salvage (partial splenectomy and splenorrhaphy) was done in about one-third of our patients [Table 3] to avert the occurrence of overwhelming postsplenectomy infection (OPSI). Other associated injuries in these patients were managed accordingly depending on the organ/system involved in conjunction with other subspecialties.

Complications encountered during the course of managing these patients in this study were predominantly infective (45.5%), although none of our patients developed OPSI. Deep venous thrombosis (DVT) occurred in 1 (3%) patient. This was noticed on the postoperative day 4 when the patient complained of swollen left lower limb. The diagnosis was confirmed by Doppler scan, and the patient was managed successfully on low-molecular-weight heparin. Other supportive measures include in the prevention of DVT include early mobilization of patients, deep breathing exercises as well as adequate hydration.[12]


  Conclusion Top


Blunt abdominal traumas due to vehicular accidents were a significant cause of splenic injuries in this study. The timely intervention was achieved in our series, and all our patients were managed operatively. Splenectomy was the most performed procedure for splenic trauma. The current management of splenic injuries entails a multidisciplinary approach. A sound clinical acumen is required of practitioners in this environment to take a prompt and appropriate decision.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Whitfield CG, Shiwani MH, Garner JP. The modern management of splenic injury: A model for coordinated trauma services. J Pak Med Assoc 2009;59:503-4.  Back to cited text no. 1
    
2.
Nyongole OV, Akoko LO, Njile IE, Mwanga AH, Lema LE. The pattern of abdominal trauma seen at Muhimbili National Hospital, Dar es Salaam, Tanzania. East Cent Afr J Surg (Online) 2013;18:40-7.  Back to cited text no. 2
    
3.
Dogo D, Yawe T, Hassan AW, Tahir B. Pattern of abdominal trauma in North Eastern Nigeria. Niger J Surg Res 2000;4:48-51.  Back to cited text no. 3
    
4.
Iribhogbe PE, Okolo CJ. Management of splenic injuries in a university teaching hospital in Nigeria. West Afr J Med 2009;28:308-12.  Back to cited text no. 4
    
5.
Nnamonu MI, Ihezue CH, Sule AZ, Ramyil VM, Pam SD. Diagnostic value of abdominal ultrasonography in patients with blunt abdominal trauma. Niger J Surg 2013;19:73-8.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Osime CO, Oludiran OO. Penetrating abdominal injury cases admitted in University of Benin Teaching Hospital. Ann Biomed Sci 2004;3:39-44.  Back to cited text no. 6
    
7.
Ayoade BA, Salami BA, Tade AO, Musa AA, Olawoye OA. Abdominal injuries in Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria: Pattern and outcome. Niger J Orthop Trauma 2006;5:45-9.  Back to cited text no. 7
    
8.
Chalya PL, Mabula JB. Abdominal trauma experience over a two-year period at a tertiary hospital in North-Western Tanzania: A prospective review of 396 cases. Tanzan J Health Res 2013;15:1-13.  Back to cited text no. 8
    
9.
Afuwape O, Ogole G, Ayandipo O. Splenectomy in a Nigerian Teaching Hospital: A comparison of sonographic correlation with intra-operative findings in trauma. J Emerg Trauma Shock 2013;6:186-8.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Oguntola AS, Aderounmu AO, Adeoti ML, Olatoke SA, Bello RO, Rabiu TB. Splenic operations in a teaching hospital, South-Western Nigeria. Sahel Med J 2008;11:15-9.  Back to cited text no. 10
  [Full text]  
11.
Agbakwuru EA, Akinkuolie AA, Sowande OA, Adisa OA, Alatise OI, Onakpoya UU. Splenic injuries in a semi urban hospital in Nigeria. East Cent Afr J Surg 2008;13:95-100.  Back to cited text no. 11
    
12.
Datta I, Ball CG, Rudmik L, Hameed SM, Kortbeek JB. Complications related to deep venous thrombosis prophylaxis in trauma: A systematic review of the literature. J Trauma Manag Outcomes 2010;4:1.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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