Blunt splenic trauma: Assessment, management and outcomes.
BACKGROUND
The approach for diagnosis and management of blunt splenic injury (BSI) has been considerably shifted towards non-operative management (NOM). We aimed to review the current practice for the evaluation, diagnosis and management of BSI.


METHODS
A traditional narrative literature review was carried out using PubMed, MEDLINE and Google scholar search engines. We used the keywords "Traumatic Splenic injury", "Blunt splenic trauma", "management" between December 1954 and November 2014.


RESULTS
Most of the current guidelines support the NOM or minimally approaches in hemodynamically stable patients. Improvement in the diagnostic modalities guide the surgeons to decide the timely management pathway Though, there is an increasing shift from operative management (OM) to NOM of BSI; NOM of high grade injury is associated with a greater rate of failure, prolonged hospital stay, risk of delayed hemorrhage and transfusion-associated infections. Some cases with high grade BSI could be successfully treated conservatively, if clinically feasible, while some patients with lower grade injury might end-up with delayed splenic rupture. Therefore, the selection of treatment modalities for BSI should be governed by patient clinical presentation, surgeon's experience in addition to radiographic findings.


CONCLUSIONS
About one-fourth of the blunt abdominal trauma accounted for BSI. A high index of clinical suspicion along with radiological diagnosis helps to identify and characterize splenic injuries with high accuracy and is useful for timely decision-making to choose between OM or NOM. Careful selection of NOM is associated with high success rate with a lower rate of morbidity and mortality.
Department of Surgery, Hamad General Hospital, Doha, Qatar.
Moamena
M
El-Matbouly
Department of Surgery, Hamad General Hospital, Doha, Qatar.
Gaby
G
Jabbour
Clinical Research, Trauma Surgery, Hamad General Hospital, Doha, Qatar; Clinical Medicine, Weill Cornell Medical College, Doha, Qatar. Electronic address: aymanco65@yahoo.com.
Ayman
A
El-Menyar
Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.
Ruben
R
Peralta
Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.
Husham
H
Abdelrahman
Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.
Ahmad
A
Zarour
Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.
Ammar
A
Al-Hassani
Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.
Hassan
H
Al-Thani
D000007:Abdominal Injuries; D019468:Disease Management; D006801:Humans; D015601:Injury Severity Score; D013154:Spleen / Q000293:injuries*; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy
Blunt trauma; Evaluation; Management; Outcome; Splenic injury