Splenic injuries at Bugando Medical Centre in northwestern Tanzania: a tertiary hospital experience

BMC Research Notes

Japhet M Gilyoma¹  Mabula D Mchembe²  Ramesh M Dass¹  Alphonce B Chandika¹  Geofrey Giiti¹  Joseph B Mabula¹  Phillipo L Chalya¹ 

[1] Department of Surgery, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania;Department of Surgery, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania

关键词: Tanzania;    Predictors of outcome;    Treatment outcome;    Injury characteristics;    Aetiological spectrum;    Splenic injuries;   

Others  :  1166729
DOI  :  10.1186/1756-0500-5-59

 received in 2011-10-28, accepted in 2012-01-23,  发布年份 2012

【 摘 要 】

Background

Splenic injuries constitute a continuing diagnostic and therapeutic challenge to the trauma or general surgeons practicing in developing countries where sophisticated imaging facilities are either not available or exorbitantly expensive. The purpose of this review was to describe our own experience in the management of the splenic injuries outlining the aetiological spectrum, injury characteristics and treatment outcome of splenic injuries in our local environment and to identify predictors of outcome among these patients.

Methods

A prospective descriptive study of splenic injury patients was carried out at Bugando Medical Centre in Northwestern Tanzania between March 2009 and February 2011. Statistical data analysis was done using SPSS software version 17.0.

Results

A total of 118 patients were studied. The male to female ratio was 6.4:1. Their ages ranged from 8 to 74 years with a median age of 22 years. The modal age group was 21-30 years. The majority of patients (89.8%) had blunt trauma and road traffic accidents (63.6%) were the most frequent cause of injuries. Most patients sustained grade III (39.0%) and IV (38.1%) splenic injuries. Majority of patients (86.4%) were treated operatively with splenectomy (97.1%) being the most frequently performed procedure. Postoperative complications were recorded in 30.5% of cases. The overall length of hospital stay (LOS) ranged from 1 day to 120 days with a median of 18 days. Mortality rate was 19.5%. Patients who had severe trauma (Kampala Trauma Score II ≤ 6) and those with associated injuries stayed longer in the hospital (P < 0.001), whereas age of the patient, associated injuries, trauma scores (KTS II), grade of splenic injuries, admission systolic blood pressure ≤ 90 mmHg, estimated blood loss > 2000 mls, HIV infection with CD4 ≤ 200 cells/μl and presence of postoperative complications were significantly associated with mortality (P < 0.001).

Conclusion

Trauma resulting from road traffic accidents (RTAs) remains the most common cause of splenic injuries in our setting. Most of the splenic injuries were Grade III & IV and splenectomy was performed in majority of the cases. Non-operative management can be adopted in patients with blunt isolated and low grade splenic injuries but operative management is still indispensable in this part of Tanzania. Urgent preventive measures targeting at reducing the occurrence of RTAs is necessary to reduce the incidence of splenic injuries in our centre.

【 授权许可】

   
2012 Chalya et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Kucuk ON, Gultekin SS, Aras G: Evaluation of a traumatic spleen laceration with spontaneous regression by selective spleen scintigraphy. Clin Nucl Medi 2007, 32:141-144.
• [2]Tariq SM, Ismail A, Sajjad A: Experience with splenic trauma in Ayub teaching hospital, Abbottabad. J Ayub Med Coll Abbottabad 2007, 19(3):3-5.
• [3]Muhammad G, Ahmad S: Splenectomy indications hazards and alternatives. J Ayub Med Coll Abbottabad 1988, 1:34-9.
• [4]Costa g, Tierno SM, Tommassinni P, Venturini L, Frezza B, Cancrini G, Stella F: The epidemiology and clinical evaluation of abdominal trauma: an analysis of a multidisciplinary trauma registry. Ann Ital Chir 2010, 81:95-102.
• [5]Taché S, Mbembati N, Marshall N, Tendick F, Mkony C, O'Sullivan P: Addressing gaps in surgical skills training by means of low-cost simulation at Muhimbili University in Tanzania. Hum Resour Heal 2009, 7:64. BioMed Central Full Text
• [6]Bugando Medical Centre: Medical record database. 2009.
• [7]Al-Qahtani MS: The pattern and management outcomes of splenic injuries in the Assir region of Saudi Arabia. West Afr J Med 2004, 23(1):1-6.
• [8]Khan JS, Iqbal N, Gardezi JR: Pattern of visceral injuries following blunt abdominal trauma in motor vehicular accidents. J Coll Physicians Surg Pak 2006, 16(10):645-647.
• [9]Khan A: Stab wounds abdomen: an experience with 105 laparotomies. J Ayub Med Coll Abbottabad 1999, 11:6-8.
• [10]Haan JM, Bochicchio GV, Kramer N, Scalea TM: Non-operative management of blunt splenic injury: a 5-year experience. J Trauma 2005, 58:492-8.
• [11]Tan KK, Chiu MT, Vijayan A: Management of isolated splenic injuries after Blunt Trauma: an institution's experience over 6 years. Med J Malaysia 2010, 65(4):306-8.
• [12]Kamel R, Manar ET, Kamel RR: Surgery of the spleen: splenic conservation. J Surg Pakistan 2000, 5:20-8.
• [13]Agbakwuru EA, Akinkuolie AA, Sowande OA, Adisa OA, Alatise OI, Onakpoya UU, Uhumwango O, Adesukanmi ARK: Splenic Injuries in a Semi Urban Hospital in Nigeria. East and Cen Afr J of Surg 2008, 13(1):95-100.
• [14]Harbrecht BG: Is anything new in adult blunt splenic trauma? Am J Surg 2005, 190(2):273-278.
• [15]Ohanaka EC, Osime U, Okonkwo CE: A five year review of splenic injuries in the University of Benin Teaching Hospital, Benin City, Nigeria. West Afr J Med 2001, 20(1):48-51.
• [16]Alli N: Management of blunt abdominal trauma in Maiduguri: a retrospective study. Niger J Med 2005, 14(1):17-22.
• [17]Osifo OD, Enemudo RE, Ovueni ME: Splenic injuries in children: the challenges of non-operative management in a developing country. J Indian Assoc Pediatr Surg 2007, 12(4):209-213.
• [18]Mutooro SM, Mutakooha E, Kyamanywa P: A comparison of Kampala Trauma score II with the new injury severity score in Mbarara University Teaching Hospital in Uganda. East and Cent Afr J of Surgery 2010, 15(1):62-70.
• [19]Moore EE, Cogbill TH, Jurkovich GJ, Shackford SR, Malangoni MA, Champion HR: Organ injury scaling: Spleen and liver. J Trauma 1995, 38:323-324.
• [20]Edino ST: Pattern of abdominal injuries in Aminu Kano Teaching Hospital, Kano. Nigerian Postgrad Med J 2003, 10(1):56-59.
• [21]Mohanta PK, Ghosh A, Pal R, Pal S: Blunt splenic injury in Sikkimese children and adolescents. J Emerg Trauma Shock 2011, 4:217-221.
• [22]Iribhogbe PE, Okolo CJ: Management of Splenic Injuries in a University Teaching Hospital in Nigeria. West Afr J Med 2009, 28(5):309-312.
• [23]Carlin AM, Tyburski JG, Wilson RF, Steffes C: Factors affecting the outcome of patients with splenic trauma. Am Surg 2002, 68(3):232-239.
• [24]Urassa M, Isingo R, Kumogola Y, Mwidunda P, Helelwa M, Changulucha J, Mngara J, Zaba B, Calleja T, Slaymaker E: Effect of PMTCT availability on choice of ANC in Mwanza and Magu districts and its impact on HIV sentinel surveillance. Tanzania: Report of ANC surveillance Mwanza and Magu Districts; 2007.
• [25]Upadhyaya P: Conservative management of splenic trauma: history and current trends. Pediatr Surg Int 2003, 19(9-10):617-627.
• [26]Schwab CW: Selection of nonoperative management candidates. World J Surg 2001, 25:1389-1392.
• [27]Githaiga JW, Adwok JA: Diagnostic peritoneal lavage in the evaluation of abdominal trauma using the dipstick. East Afr Med J 2002, 79(9):457-460.
• [28]Ameh EA, Chirdan LB, Nmadu PT: Blunt abdominal trauma in children: epidemiology, management and management problem in a developing country. Pediatr Surg Int 2000, 16:505-509.
• [29]Kang EG, Sharma GK, Lozano R: The global burden of injuries. Am J Public Health 2000, 90:523-526.
• [30]Davidson RN, Wall RA: Prevention and management of infections in patients without a spleen. Clin Microbiol Infect 2001, 7(12):657-660.
• [31]El-Alfy MS, El-Sayed MH: Overwhelming post-splenectomy infection: is quality of patient knowledge enough for prevention? Hematol J 2004, 5(1):77-80.
• [32]Ohanaka EC: Discharge against medical advice. Trop Doc 2002, 32:149-151.