Experience in managing splenic trauma on the Jos Plateau

We studied retrospectively, fifty eight (58) patients with splenic injury admitted to Jos University Teaching Hospital between October 1988 and September, 1995. Forty-nine were males while nine were females (M:F = 5.4:1). The age ranged from 5 to 50 years with a mean of 24.5 years. The highest incidence was recorded in the third decade of life. Road Traffic Accident (RTA) was the commonest (75.8%) cause of splenic injury; others were fall from heights 7 (12.1%), blows to the abdomen 5 (8.6%) and stab wounds to the abdomen 2 (3.5%). Of the 58 cases, 56 (96.5%) were blunt abdominal injuries while 2 (3.5%) were penetrating stab injuries. All had laparotomy. 13 (22.4%) sustained Upadhyaya and Simpson's type 1 injury, 18 (31.0%) type II, 12 (20.7%) type III and 15 (25.9%) type IV injuries. Of the 58 patients, 29 (50%) had total splenectomy without heterotopic autotransplantation (HAT); 21 (36.2%) had splenectomy with HAT, while 8 (13.8%) had splenorrhaphy with omentoplasty. The average number of units of blood transfused was 2.3 units per patient. There were four (6.9%) deaths--two as a result of shock and multiple organ failure and another two died as a result of pulmonary embolism. However the commonest post operative complications were chest and wound infections. The rate of splenic salvage in this study was low despite the fact that most of these patients sustained types I and II injuries. We believe a greater salvage rate could be achieved and the trend in our centre now is toward splenic conservation.