Management of Splenic Injuries in a University Teaching Hospital in Nigeria

BACKGROUND: Management of spleen injuries has undergone evolution over the past few decades. OBJECTIVE: To assess the challenges of managing splenic injuries in Nigeria. METHODS: The medical records of all adult trauma patients with documented injury of the spleen over a two-year period (2006-2008) were reviewed. Data collected included patient demographics, mechanism of injury, injury-arrival time, Revised Trauma Score, abdominocentesis, abdominal ultrasound and CT findings. Treatment received, outcome and length of hospital stay were also documented. RESULTS: Twenty-three patients were managed for splenic injuries during the period under review. These consisted of 21 (91.3%) males and two (8.7%) females. The age range was 16–58 years (mean of 29.6±12.2 years). The mechanism of injury was blunt in 21 cases and penetrating in two cases with motor vehicle accident being the most common cause of injury. The mean injury-arrival time was 25.2±26.5 hours. Eight patients successfully underwent non-operative management, while 15 had operative intervention. Splenectomy was the most frequently performed procedure. Challenges identified in the management of patients with splenic injuries in Nigeria include delayed presentation, underutilization of CT, unavailability of interventional radiology, inadequate ICUs, limited vaccination, discharge against medical advice and poor follow up. CONCLUSION: Non-operative management of injuries to the spleen in adults appears promising. The challenges identified need to be addressed in order to deliver optimal care for the victims of spleen trauma.