RECHERCHES SCIENTIFIQUES

FACTEURS PRÉDICTIFS D’ÉCHEC DU TRAITEMENT NON OPÉRATOIRE DU TRAUMATISME SPLÉNIQUE

Référence955
Année2015
TypeThèse
Lien document
AuteurRahhali S
DisciplineCentre Hospitalier Universitaire Mohammed VI d'Oujda
EncadrantSoufi M

INTRODUCTION :Trauma of the spleen among adults is a pathology of relative severety and frequency. They seem to be increasing with the increase of in traffic accidents.In the presence of hemodynamic instability, splenectomy remains the most appropriate procedure that will save the patient’s life; currently the non-operative treatment of splenic blunt trauma preserves immune function of the spleen and avoid useless laparotomyThe aim of this study was to evaluate the feasibility of conservative treatment of blunt splenic injuries among adults and identify the predictors of its failure .
MATERIALS AND METHODS:Our work is a retrospective study of 34 cases of splenic trauma collected within visceral surgery departments 1 and 2 of AL-Farabi CHR Oujda during a 3-year period from January 2011 to December 2013.
RESULTS:We collected 34 patients; there was a high frequency of splenic trauma during the summer, with a male predominance. The average age was 30.62 years, ranging from 17 years to 57 years.In our study, the abdominal wounds were the main reason for hospitalization with a rate of 44.1%. Bruises occupied the second position with a rate of 35.3% .The circumstances of the injury were mainly aggression representing (44.1%) followed by road accidents (38.2%) and falls with a percentage of (17.6%).20.6% had toxic habits, 8.8% had hypertension and 8.8% had diabetes Clinically 44.1% of patients were hemodynamically stable. Abdominal tenderness was the main symptom 61.8% of patients, followed by abdominal defense with a rate of 17.6% of cases, and finally contracture in 5.9% of patients.Biologically35.2% had hemoglobin less than 9 g / dl and 42.2% had high leukocytosis, prothrombin time was normal in all patients.Radiologically, an abdomen without preparation was performed in only 17% of patients. Ultrasonography was performed in 94.1% of patients showing spleen lacerations in first place with an estimated rate of 29.4%, splenic fracture was second found among 26.5% of patients followed by Hemoperitoneum with a rate of 23.5%.
Abdominal CT scans, done in 32 cases 91.2%, showed spleen laceration in 23.5%, a unipolar splenic fracture in 29.4%, a multipolar splenic fracture in 8.8% of cases and 8.8% of splenic pedicle is reached, and 20.6 % of ruptured spleen. 10patients or 29.4% of cases received nonoperative treatment. splenectomy was performed in 44.8% of cases.32% of cases underwent conservative surgery which 20.2% are partial splenectomy and 11.8% of splenic sutures.The predictive factors of failure of non-operative treatment in our series were tachycardia Hemoperitoneum,hemodynamic instability, associated vascular lesions,a hemoglobin rate below 9 g / dl.and transfusion of more than 2 packed red blood cells .
CONCLUSION:Currently splenectomy is no longer regarded as the only treatment of traumatic lesions of the spleen, because its risk of infection both among child and adult.The operative abstention and conservative surgery is increasingly performed if the hemodynamic condition is stable, and the means of surveillance available