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Clinical Trial
. 2017 Jul 25:12:33.
doi: 10.1186/s13017-017-0144-3. eCollection 2017.

Non-operative management for penetrating splenic trauma: how far can we go to save splenic function?

Roy Spijkerman  1 , Michel Paul Johan Teuben  1 , Fatima Hoosain  2 , Liezel Phyllis Taylor  2 , Timothy Craig Hardcastle  3 , Taco Johan Blokhuis  1 , Brian Leigh Warren  2 , Luke Petrus Hendrikus Leenen  1
Affiliations
Clinical Trial

Non-operative management for penetrating splenic trauma: how far can we go to save splenic function?

Roy Spijkerman et al. World J Emerg Surg. .

Abstract

Background: Selective non-operative management (NOM) for the treatment of blunt splenic trauma is safe. Currently, the feasibility of selective NOM for penetrating splenic injury (PSI) is unclear. Unfortunately, little is known about the success rate of spleen-preserving surgical procedures. The aim of this study was to investigate the outcome of selective NOM for penetrating splenic injuries.

Methods: A dual-centre study is performed in two level-one trauma centres. All identified patients treated for PSI were identified. Patients were grouped based on the treatment they received. Group one consisted of splenectomised patients, the second group included patients treated by a spleen-preserving surgical intervention, and group three included those patients who were treated by NOM.

Results: A total of 118 patients with a median age of 27 and a median ISS of 25 (interquartile range (IQR) 16-34) were included. Ninety-six patients required operative intervention, of whom 45 underwent a total splenectomy and 51 underwent spleen-preserving surgical procedures. Furthermore, 22 patients (12 stab wounds and 10 gunshot wounds) were treated by NOM. There were several anticipated significant differences in the baseline encountered. The median hospitalization time was 8 (5-12) days, with no significant differences between the groups. The splenectomy group had significantly more intensive care unit (ICU) days (2(0-6) vs. 0(0-1)) and ventilation days (1(0-3) vs. 0(0-0)) compared to the NOM group. Mortality was only noted in the splenectomy group.

Conclusions: Spleen-preserving surgical therapy for PSI is a feasible treatment modality and is not associated with increased mortality. Moreover, a select group of patients can be treated without any surgical intervention at all.

Keywords: Gunshot wound; Mortality; Non-operative; Penetrating; Spleen; Stab wound; Trauma.

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Conflict of interest statement

Ethics approval and consent to participate

We received approval from the Health Research Ethics Committee (HREC) 2 at the Stellenbosch University on April 11, 2014, for our data research at the Tygerberg Hospital (protocol number: S14/02/046).

Approval for our research in the Inkosi Albert Luthuli Central Hospital was received from the University of Kwazulu-Natal Biomedical Research Ethics Committee (protocol number: UKZN BREC BE207-09).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

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Treatment protocol
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Flowchart
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