Rajarajeswari, K (2013) A Prospective study on Splenic Injury. Masters thesis, K.A.P. Viswanatham Government Medical College, Tiruchirappalli.
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Abstract
INTRODUCTION: An injured spleen is a well-known entity to those involved in trauma care. The majority of individual with a splenic injury now receive nonoperative intervention and therapy. This shift from operative to nonoperative treatment over the past several decades is a tremendous success story in which clinical judgment and reason triumphed over standard surgical dogma. Furthermore, this success has prompted surgeons to adopt similar management strategies for other solid organ injuries. Recent work with clinical outcomes data in splenic trauma has given rise to model clinical practice guidelines. These guidelines serve to standardize and justify management decisions based on the best possible data and accepted clinical parameters. AIM OF THE STUDY: The aim of the study is to evaluate the following aspects: 1. To evaluate the impact of blunt or penetrating abdominal trauma on spleen. 2. To evaluate various modes of injury. 3. To evaluate various modes of clinical presentation of cases. 4. To evaluate the value of various available investigations employed. 5. To evaluate the various methods of treatment. 6. To evaluate various associated injuries occurring. 7. To evaluate the morbidity and mortality. MATERIALS AND METHODS: This study was a prospective study of 20 cases of splenic injury abdomen admitted in the triage ward of Mahatma Gandhi Memorial Government Medical College Hospital -Trichy, from October 2010 to October 2012. Once the patient is admitted the name, age, sex and mode of injury are noted. The time interval between splenic injury and admission and time interval between admission to hospital and surgery are recorded. After resuscitating the patient, all patients were subjected to careful clinical examination. Depending on the clinical findings, decision was taken for further investigations such as four-quadrant aspiration, X-ray abdomen, ultrasound and CT abdomen . The decision for operative & non-operative management depended upon the outcome of clinical examination & diagnostic tests. Patients selected for conservative management were placed on strict bed rest, serial clinical examination which included hourly pulse rate, blood pressure, respiratory rate and repeated abdominal examination. In those who are operated, the operative findings and methods of management are recorded. Cases are followed up till their discharge from the hospital. If patient expired postmortem findings are noted. Post operative morbidity and duration of hospital stay were recorded. The above facts are recorded in a proforma prepared for this study. OBSERVATIONS AND RESULTS: The total number of patients who had sustained splenic injuries were 20. In this study of the 20 patients 15 cases were male and 5 cases were females. The increase in the incidence of association of males is due to acts of violence and vehicular accidents. CONCLUSION: • Road traffic accident is the commonest cause for splenic injury Abdomen. • Predominance of male over female in splenic injury abdomen with the ratio of 3:1. • People in the age group of 3rd & 4th decade were commonly involved in splenic injury abdomen constituting about 55 %. • Based upon the grading of injuries and hemodynamic stability of the patient and other associated injuries, decision of laparatomy versus conservative management decision was taken. • 12 patients were managed surgically,8 underwent splenectomy and 4 underwent splenorrhaphy by topical hemostatic agents and sutural repair. • Overall mortality due to splenic injury abdomen was 15%. • Sepsis and associated injury were the major causes of death.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Splenic Injury ; Prospective study. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Devi S |
| Date Deposited: | 03 May 2018 04:34 |
| Last Modified: | 03 May 2018 11:49 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7410 |
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