Management Of Spleen Trauma In Damascus Hospital

Management Of Spleen Trauma In Damascus Hospital | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Management Of Spleen Trauma In Damascus Hospital Sara Albaghajati, Samer Sara This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4817905/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: Our study aims to study blunt and penetrating traumatic splenic injuries, their management methods (Surgical or conservative) and complications. Methods: A retrospective cohort study was conducted in the Department of Surgery at Damascus Hospital between 2015 and 2023. The study included all patients who suffered from penetrating and blunt traumatic splenic injury and were admitted to the surgery department. Data and information were tabulated using Excel spreadsheet program and then data were analyzed using SPSS-25. The results were compared with international studies according to mortality and morbidity rates perioperatively. Results: The study included 98 patients (mean age 19.03 years with standard deviation 17.46 years, male and female ratio 71.4% and 28.6% respectively), 99% of blunt injuries, 1% of penetrating injuries, most of the injuries were grade IV (45.6% of 22 patients), most of the injuries were isolated (92.9%), 86% of stable patients (n=86) were treated surgically (91.9% excisional surgery, 8.1% conservative surgery), and 14% of them were treated conservatively, most of the unstable patients were treated surgically (91.7% excisional treatment, 8.3% conservative surgery), mortality rate 11.2% of all patients. conclusion: Allocating a section in the emergency intensive care unit to follow up on patients with abdominal trauma, which is supervised and followed up by a specialized team that ensures close monitoring of the patient in the required manner, with the possibility of conducting radiological and laboratory investigations within this section at the required speed and at any time. General Surgery spleen blunt trauma penetrating trauma conservative treatment surgical treatment Introduction The spleen is an intraperitoneal organ that results from the differentiation of mesenchymal cells along the left side of the stomach and is located in the upper left quadrant of the abdomen. It weighs about 150–200 grams and may be bruised by stabbing with a sharp object, gunshots, or car accidents. Less than two decades ago, the first choice was always splenectomy. However, based on new research and clinical experience, there is a tendency to preserve the spleen as much as possible, due to its immune function and the risk of sepsis. Based on the WSES classification, splenic trauma can be classified into mild, moderate, and severe [ 1 – 2 ]. The treatment protocol for splenic trauma has changed significantly in the past decades, especially non-surgical treatment (NOM), which used to include total or partial splenectomy, monitoring, and direct hemostasis with medications or a hemostatic device. Currently, treatments such as monitored nutrition, rest, and drug therapy with anticoagulants and antibiotics are followed when necessary [ 3 ]. The goal of treatment of patients with splenic trauma is to restore balance The normal physiology, taking into account modern methods of stopping bleeding, and therefore treatment should be multidisciplinary and depends on the patient's condition, the location and position of the injury, and whether the injury is isolated or accompanying. Most splenic bruises in patients can be treated without surgery through conservative treatment or conservative surgery, which is a blunt splenectomy, which helps in reconstructing the spleen itself and reducing the risk of infection with meningococcal and pneumococcus, and thus reducing the number of deaths resulting from infection after surgery. Vaccines should also be given to all patients who have undergone splenectomy 14 days after the surgical procedure [ 4 ]. Methods and materials The importance of the research and its objectives Due to the circumstances that the country has gone through, the exposure to penetrating and blunt trauma to the spleen has increased, which can be treated conservatively or surgically according to each case. The spleen is a highly sensitive and fragile organ, and has immune and blood functions, which makes preserving it of great importance. A penetrating or blunt trauma may cause severe bleeding that may lead to death. Therefore, we need to study treatment methods, complications, post-operative outcomes, and deaths. Research justifications The lack of local studies evaluating the methods of managing spleen injuries in local hospitals compared to international studies. Methods and materials Study sample: The research sample included patients admitted to the General Surgery Department at Damascus Hospital with a history of abdominal trauma with a diagnosis of splenic injury between 2015 and 2023. Study type: prospective retrospective study Study location: Damascus Hospital (Al-Mujtahid) Data collection: Data were collected through a paper form and by referring to the patient records in the hospital archives. The form included age, gender, type of trauma in the patient, symptoms and signs suffered by the patient, radiological diagnosis of the patient, the degree of splenic injury was determined for each case according to the splenic injury grade scale approved by the American Society for Trauma Surgery, the presence of abdominal injuries accompanying splenic rupture and the methods followed in treating the stable patient, and the type of conservative management performed for the patient who was hemodynamically stable. Also, monitoring methods were searched for in patients (hematocrit, vital signs, hemoglobin and vital signs, and ultrasound and CT scan). Data and information were organized using the Excel spreadsheet program, and then the data were analyzed using the SPSS-25 program. The results were compared with international studies according to mortality and morbidity rates around surgery. Statistical methods used: Descriptive analysis (frequencies and percentages) was found for all variables in the study, and the inferential analysis included studying the existence of relationships and correlations between many of the studied variables, where Pearson χ2 was conducted for univariate categorical analysis, and the Student t-test for independent samples was used for univariate analysis of continuous variables. SPSS version 25 was used to conduct all analyses, and p < 0.05 was considered a statistically significant value. Results The sample size of our study was 98 patients. We found that the mean age of the patients was 19.03 years with a standard deviation of 17.46 years. The age of the patients ranged from 2 years to 85 years. The percentage of males was 71.4%, and the percentage of females was 28.6%. The percentage of those with blunt trauma was 99%, and those with penetrating trauma was 1%. Pain in the left hypochondrium was found in 86 patients (87.8%), and signs of hypovolemic shock were found in 12 patients (12.2%). Among the patients with hypovolemic shock, tachycardia, hypotension, and dry mucous membranes were found in all of them, while oliguria was found in only 3 patients (25%). In this sample of patients, echo was performed for all shocked patients (12.2%), CT scan was performed for 7.1% of stable patients, CT scan and echo were performed for 13.3% of stable patients, and no radiological examination was performed for the remaining stable patients (67.3%). We found that 22 patients (22.4%) had a spleen grade determined, among them the most common was grade IV spleen damage (45.6%), followed by grade II and V spleen damage (18.2%) each, followed by grades I and III (9.1%) each, and 77.6% of patients did not have a specific grade of damage. We found that the percentage of lesions accompanying spleen damage was 7.1%, and the percentage of isolated lesions was 92.9%. We previously mentioned that the number of stable patients was 86 patients, representing 87.8%, 74 patients, representing 86%, were treated surgically (excisional surgery or conservative surgery), and 12 patients, representing 14%, were treated conservatively. We previously mentioned that the number of patients who underwent surgical treatment was 74 patients, representing 86%, and among these patients, 91.9% of them underwent excisional surgery, and 8.1% of them underwent conservative surgery. The average duration of monitoring for all patients was 4.56 days with a standard deviation of 3.45 days, and the values ​​ranged between one day and 20 days. 91.7% of the shocked patients were treated with splenectomy, while 8.3% were treated conservatively. Most patients, representing 86.7%, were monitored for vital signs every 24 hours, 8.2% of patients were monitored for vital signs every 12 hours, and 2% of them were monitored every two days. 74.5% of patients had an abdominal examination every 24 hours, while 9.2% of patients had an examination every 12 hours. We found that 16.3% did not have an abdominal examination during follow-up. Only 9.2% of patients underwent ultrasound monitoring every 8 hours, 8.2% of patients underwent ultrasound monitoring every 6 hours, only 6.1% of patients underwent monitoring every 24 hours, 1% underwent monitoring every two days, 2% underwent monitoring every 12 hours, and the remaining patients (73.5%) were not monitored. The percentage of CT monitoring upon admission only was 20.5%, the percentage of CT upon admission and discharge was 2%, and those who were not monitored by CT were 78.5%. The number of patients who underwent blood transfusion while in the hospital was 69 patients (70.4%), and the average number of transfused units was 2.45 units with a standard deviation of 1.9 units, and the values ​​ranged between 1 and 9 units. The mortality rate in patients with splenic injury was 11.2%, the overall complications rate was 4.08%, the incidence of embolism was 50%, while the incidence of pneumonia and wound infection was 25% each. Relationship between the degree of injury and the management of the stable patient In this group of patients, all patients with grade I were managed conservatively, 75% of patients with grade II were managed conservatively, 100% of patients with grade III were managed conservatively, 100% of patients with grade IV were managed by excisional surgery, and 25% of patients with grade V were managed by excisional surgery with statistical significance (P = 0.000). Relationship between the degree of injury and the management of the unstable patient In this group of patients, we found that 75% of patients with grade V were treated with total splenectomy and 25% of patients with grade II were treated with partial excision with statistical significance (P = 0.000). Discussion In our study, we found that the percentage of males is higher than that of females in patients with splenic trauma, 71.4% and 28.6% respectively, which are close to the global, Arab and local percentages. In our study, blunt trauma constitutes the largest percentage of splenic trauma, and traffic accidents constitute the most common cause of splenic trauma worldwide, while penetrating trauma was almost non-existent in our study, which is similar to some global studies, and differs from each other in terms of the type of injury. Patients with fourth-degree injuries constitute the largest percentage in our study, while patients with first and third-degree injuries constitute the lowest percentage, which is different from the global percentages, and the percentage of cases accompanied by concomitant abdominal injuries is less than in other global, Arab and local studies. The radiological investigation used in the trauma patient in our study was an echocardiogram at a rate of 12.2%, and the rate of using axial tomography in stable patients only was 7.1%, and the rate of using tomography and echocardiography in a stable patient was 13.3%. This is different from international studies, as in other studies all patients were subjected to an axial tomography procedure with contrast injection in the case of penetrating injuries, while in the case of blunt injuries, echocardiography was used as a primary investigation for all patients and was later completed with an axial tomography procedure with contrast injection in selected cases to achieve adequate assessment of the case. The rate of injuries that were managed surgically was high compared to international studies, which reduces the surgeons’ lack of reliance on non-surgical management (this may explain the surgeons’ lack of confidence in the results of non-surgical treatment for such patients, so surgeons resort to performing surgical intervention early because they have more confidence in the results of their surgical intervention in preserving the patient’s life than their confidence in the results of monitoring the patient in the hospital, especially unstable patients). All patients with grade 5 were treated surgically, whether stable or unstable. 25% of grade 2 and unstable patients were treated surgically, and 75% of grade 2 and stable patients were treated conservatively. All grade 4 patients were treated surgically despite being stable. All grade 3 and 1 patients were treated conservatively because they were stable, consistent with international studies in terms of management. Surgical management was based in all cases on close monitoring of vital signs and periodic abdominal ultrasound with hemodynamic support. Splenic artery bypass was not performed in any of the cases due to the unavailability of the necessary materials for this technique in the hospital, as it is managed using it in about 20–30% of cases in other studies. Postoperative complications diagnosed in our study sample were, in order of prevalence, embolisms 50%, wound infection and pneumonia 25% each. The mortality rate in the study sample was 11.5%, and most deaths were due to neurological, brain and heart injuries, which is close to international rates. Declarations Ethical approval: The Research Ethics Committee at Syrian Private University and the ethical committees at the relevant Syrian Private University approved the study protocol, Verbal informed consent was obtained from the participant All procedures performed in studies involving the participant and human subjects were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards Consent for publication: Not applicable. Availability of data and materials: All data produced in the present work are contained in the manuscript Conflict of interest: The authors declare that they have no Conflict of interest: Funding: Unavailable Acknowledgments: We are thankful to the management of the Syrian Private University for their support in the eld of medical training and research. We would also like to thank Dr. samer Sara for his help and supervision in the paper, we would like to thank the male and female students participating in the study. References Van der Vlies CH, Olthof DC, Gaakeer M, Ponsen KJ, van Delden OM et al (2018) Changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs. Int J Emerg Med 4: 47. Link: https://pubmed.ncbi.nlm.nih.gov/2179410 Costa G, Tierno SM, Tomassini F, Venturini L, Frezza B et al (2017) The epidemiology and clinical evaluation of abdominal trauma. An analysis of a multidisciplinary trauma registry. Ann Ital Chir 81: 95–102. Link: https://bit.ly/3pkcB4l Richardson JD (2017) Changes in the management of injuries to the liver and spleen. J Am Coll Surg 200: 648–669. Link: https://bit.ly/3AYANLU Forsythe RM, Harbrecht BG, Peitzman AB (2006) Blunt splenic trauma. Scand J Surg 95: 146 – 51. Link: https://bit.ly/2Zg9hfU Additional Declarations The authors declare potential competing interests as follows: not thing Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4817905","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":332830972,"identity":"e61a42f2-a394-4f22-b0fd-437043eb4490","order_by":0,"name":"Sara Albaghajati","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABFklEQVRIiWNgGAWjYBACAwYGNgYGHjAJBBU2QIKx8QAxWiQgWs6kgbQ0EKGFgUECzGNsOwym8WoxZz9+7cEPGbs6Pv7Dzz78OHPebm37YaAtNTbRuLRY9uSUG/bwJEuwSaQZz+ypuJ287UwiUMuxtNwGXA47kJMmwcPDDNTCYMzAc+Z2stkBoBbGhsO4tZx/kyb5h6dego3/+GfGv23nks3OPySg5Ub6MWkensPAEMsxZuZtO2BndoOALZYz3rBJy/Acl2yTyClmljmTnGB2A2hLAh6/mPOnP5N821PNL99/fDPjmwo7e7Pz6Q8ffKixwakFGI0GDIw9CG4iWGUCTuUgwP6AgeEHgmuPV/EoGAWjYBSMSAAA34VgWCEYsCkAAAAASUVORK5CYII=","orcid":"","institution":"Faculty of medicine, Syrian Private University, Damascus, Syria.","correspondingAuthor":true,"prefix":"","firstName":"Sara","middleName":"","lastName":"Albaghajati","suffix":""},{"id":332830973,"identity":"9985d6a2-e1a0-4c11-9ea2-488a81e4567b","order_by":1,"name":"Samer Sara","email":"","orcid":"","institution":"department of Surgery almouwasat university hospital - Damascus university","correspondingAuthor":false,"prefix":"","firstName":"Samer","middleName":"","lastName":"Sara","suffix":""}],"badges":[],"createdAt":"2024-07-28 19:00:29","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4817905/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4817905/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":61387640,"identity":"6d5ec6f3-a64d-4c57-84f5-938365dc84ec","added_by":"auto","created_at":"2024-07-30 07:24:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":208356,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4817905/v1/42def9dd-f4a4-4dfc-9dd3-c1acf621439a.pdf"}],"financialInterests":"The authors declare potential competing interests as follows: not thing","formattedTitle":"\u003cp\u003e\u003cstrong\u003eManagement Of Spleen Trauma In Damascus Hospital\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe spleen is an intraperitoneal organ that results from the differentiation of mesenchymal cells along the left side of the stomach and is located in the upper left quadrant of the abdomen. It weighs about 150\u0026ndash;200 grams and may be bruised by stabbing with a sharp object, gunshots, or car accidents. Less than two decades ago, the first choice was always splenectomy. However, based on new research and clinical experience, there is a tendency to preserve the spleen as much as possible, due to its immune function and the risk of sepsis. Based on the WSES classification, splenic trauma can be classified into mild, moderate, and severe [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The treatment protocol for splenic trauma has changed significantly in the past decades, especially non-surgical treatment (NOM), which used to include total or partial splenectomy, monitoring, and direct hemostasis with medications or a hemostatic device. Currently, treatments such as monitored nutrition, rest, and drug therapy with anticoagulants and antibiotics are followed when necessary [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The goal of treatment of patients with splenic trauma is to restore balance The normal physiology, taking into account modern methods of stopping bleeding, and therefore treatment should be multidisciplinary and depends on the patient's condition, the location and position of the injury, and whether the injury is isolated or accompanying. Most splenic bruises in patients can be treated without surgery through conservative treatment or conservative surgery, which is a blunt splenectomy, which helps in reconstructing the spleen itself and reducing the risk of infection with meningococcal and pneumococcus, and thus reducing the number of deaths resulting from infection after surgery. Vaccines should also be given to all patients who have undergone splenectomy 14 days after the surgical procedure [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cp\u003eThe importance of the research and its objectives\u003c/p\u003e \u003cp\u003eDue to the circumstances that the country has gone through, the exposure to penetrating and blunt trauma to the spleen has increased, which can be treated conservatively or surgically according to each case. The spleen is a highly sensitive and fragile organ, and has immune and blood functions, which makes preserving it of great importance. A penetrating or blunt trauma may cause severe bleeding that may lead to death. Therefore, we need to study treatment methods, complications, post-operative outcomes, and deaths.\u003c/p\u003e \u003cp\u003eResearch justifications\u003c/p\u003e \u003cp\u003eThe lack of local studies evaluating the methods of managing spleen injuries in local hospitals compared to international studies.\u003c/p\u003e \u003cp\u003eMethods and materials\u003c/p\u003e \u003cp\u003eStudy sample: The research sample included patients admitted to the General Surgery Department at Damascus Hospital with a history of abdominal trauma with a diagnosis of splenic injury between 2015 and 2023.\u003c/p\u003e \u003cp\u003eStudy type: prospective retrospective study\u003c/p\u003e \u003cp\u003eStudy location: Damascus Hospital (Al-Mujtahid)\u003c/p\u003e \u003cp\u003eData collection: Data were collected through a paper form and by referring to the patient records in the hospital archives. The form included age, gender, type of trauma in the patient, symptoms and signs suffered by the patient, radiological diagnosis of the patient, the degree of splenic injury was determined for each case according to the splenic injury grade scale approved by the American Society for Trauma Surgery, the presence of abdominal injuries accompanying splenic rupture and the methods followed in treating the stable patient, and the type of conservative management performed for the patient who was hemodynamically stable. Also, monitoring methods were searched for in patients (hematocrit, vital signs, hemoglobin and vital signs, and ultrasound and CT scan). Data and information were organized using the Excel spreadsheet program, and then the data were analyzed using the SPSS-25 program. The results were compared with international studies according to mortality and morbidity rates around surgery. Statistical methods used: Descriptive analysis (frequencies and percentages) was found for all variables in the study, and the inferential analysis included studying the existence of relationships and correlations between many of the studied variables, where Pearson χ2 was conducted for univariate categorical analysis, and the Student t-test for independent samples was used for univariate analysis of continuous variables. SPSS version 25 was used to conduct all analyses, and p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered a statistically significant value.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe sample size of our study was 98 patients. We found that the mean age of the patients was 19.03 years with a standard deviation of 17.46 years. The age of the patients ranged from 2 years to 85 years. The percentage of males was 71.4%, and the percentage of females was 28.6%. The percentage of those with blunt trauma was 99%, and those with penetrating trauma was 1%. Pain in the left hypochondrium was found in 86 patients (87.8%), and signs of hypovolemic shock were found in 12 patients (12.2%). Among the patients with hypovolemic shock, tachycardia, hypotension, and dry mucous membranes were found in all of them, while oliguria was found in only 3 patients (25%). In this sample of patients, echo was performed for all shocked patients (12.2%), CT scan was performed for 7.1% of stable patients, CT scan and echo were performed for 13.3% of stable patients, and no radiological examination was performed for the remaining stable patients (67.3%).\u003c/p\u003e \u003cp\u003eWe found that 22 patients (22.4%) had a spleen grade determined, among them the most common was grade IV spleen damage (45.6%), followed by grade II and V spleen damage (18.2%) each, followed by grades I and III (9.1%) each, and 77.6% of patients did not have a specific grade of damage.\u003c/p\u003e \u003cp\u003eWe found that the percentage of lesions accompanying spleen damage was 7.1%, and the percentage of isolated lesions was 92.9%.\u003c/p\u003e \u003cp\u003eWe previously mentioned that the number of stable patients was 86 patients, representing 87.8%, 74 patients, representing 86%, were treated surgically (excisional surgery or conservative surgery), and 12 patients, representing 14%, were treated conservatively.\u003c/p\u003e \u003cp\u003eWe previously mentioned that the number of patients who underwent surgical treatment was 74 patients, representing 86%, and among these patients, 91.9% of them underwent excisional surgery, and 8.1% of them underwent conservative surgery.\u003c/p\u003e \u003cp\u003eThe average duration of monitoring for all patients was 4.56 days with a standard deviation of 3.45 days, and the values ​​ranged between one day and 20 days.\u003c/p\u003e \u003cp\u003e91.7% of the shocked patients were treated with splenectomy, while 8.3% were treated conservatively.\u003c/p\u003e \u003cp\u003eMost patients, representing 86.7%, were monitored for vital signs every 24 hours, 8.2% of patients were monitored for vital signs every 12 hours, and 2% of them were monitored every two days.\u003c/p\u003e \u003cp\u003e74.5% of patients had an abdominal examination every 24 hours, while 9.2% of patients had an examination every 12 hours. We found that 16.3% did not have an abdominal examination during follow-up.\u003c/p\u003e \u003cp\u003eOnly 9.2% of patients underwent ultrasound monitoring every 8 hours, 8.2% of patients underwent ultrasound monitoring every 6 hours, only 6.1% of patients underwent monitoring every 24 hours, 1% underwent monitoring every two days, 2% underwent monitoring every 12 hours, and the remaining patients (73.5%) were not monitored.\u003c/p\u003e \u003cp\u003eThe percentage of CT monitoring upon admission only was 20.5%, the percentage of CT upon admission and discharge was 2%, and those who were not monitored by CT were 78.5%.\u003c/p\u003e \u003cp\u003eThe number of patients who underwent blood transfusion while in the hospital was 69 patients (70.4%), and the average number of transfused units was 2.45 units with a standard deviation of 1.9 units, and the values ​​ranged between 1 and 9 units.\u003c/p\u003e \u003cp\u003eThe mortality rate in patients with splenic injury was 11.2%, the overall complications rate was 4.08%, the incidence of embolism was 50%, while the incidence of pneumonia and wound infection was 25% each.\u003c/p\u003e \u003cp\u003eRelationship between the degree of injury and the management of the stable patient\u003c/p\u003e \u003cp\u003eIn this group of patients, all patients with grade I were managed conservatively, 75% of patients with grade II were managed conservatively, 100% of patients with grade III were managed conservatively, 100% of patients with grade IV were managed by excisional surgery, and 25% of patients with grade V were managed by excisional surgery with statistical significance (P\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e \u003cp\u003eRelationship between the degree of injury and the management of the unstable patient\u003c/p\u003e \u003cp\u003eIn this group of patients, we found that 75% of patients with grade V were treated with total splenectomy and 25% of patients with grade II were treated with partial excision with statistical significance (P\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our study, we found that the percentage of males is higher than that of females in patients with splenic trauma, 71.4% and 28.6% respectively, which are close to the global, Arab and local percentages.\u003c/p\u003e \u003cp\u003eIn our study, blunt trauma constitutes the largest percentage of splenic trauma, and traffic accidents constitute the most common cause of splenic trauma worldwide, while penetrating trauma was almost non-existent in our study, which is similar to some global studies, and differs from each other in terms of the type of injury.\u003c/p\u003e \u003cp\u003ePatients with fourth-degree injuries constitute the largest percentage in our study, while patients with first and third-degree injuries constitute the lowest percentage, which is different from the global percentages, and the percentage of cases accompanied by concomitant abdominal injuries is less than in other global, Arab and local studies.\u003c/p\u003e \u003cp\u003eThe radiological investigation used in the trauma patient in our study was an echocardiogram at a rate of 12.2%, and the rate of using axial tomography in stable patients only was 7.1%, and the rate of using tomography and echocardiography in a stable patient was 13.3%. This is different from international studies, as in other studies all patients were subjected to an axial tomography procedure with contrast injection in the case of penetrating injuries, while in the case of blunt injuries, echocardiography was used as a primary investigation for all patients and was later completed with an axial tomography procedure with contrast injection in selected cases to achieve adequate assessment of the case. The rate of injuries that were managed surgically was high compared to international studies, which reduces the surgeons\u0026rsquo; lack of reliance on non-surgical management (this may explain the surgeons\u0026rsquo; lack of confidence in the results of non-surgical treatment for such patients, so surgeons resort to performing surgical intervention early because they have more confidence in the results of their surgical intervention in preserving the patient\u0026rsquo;s life than their confidence in the results of monitoring the patient in the hospital, especially unstable patients). All patients with grade 5 were treated surgically, whether stable or unstable. 25% of grade 2 and unstable patients were treated surgically, and 75% of grade 2 and stable patients were treated conservatively. All grade 4 patients were treated surgically despite being stable. All grade 3 and 1 patients were treated conservatively because they were stable, consistent with international studies in terms of management. Surgical management was based in all cases on close monitoring of vital signs and periodic abdominal ultrasound with hemodynamic support. Splenic artery bypass was not performed in any of the cases due to the unavailability of the necessary materials for this technique in the hospital, as it is managed using it in about 20\u0026ndash;30% of cases in other studies. Postoperative complications diagnosed in our study sample were, in order of prevalence, embolisms 50%, wound infection and pneumonia 25% each. The mortality rate in the study sample was 11.5%, and most deaths were due to neurological, brain and heart injuries, which is close to international rates.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Research Ethics Committee at Syrian Private University and the ethical committees at the relevant Syrian Private University approved the study protocol, Verbal informed consent was obtained from the participant All procedures performed in studies involving the participant and human subjects were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials: \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data produced in the present work are contained in the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no Conflict of interest:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding: \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnavailable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are thankful to the management of the Syrian Private University for their support in the eld of medical training and research. We would also like to thank Dr. samer Sara for his help and supervision in the paper, we would like to thank the male and female students participating in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eVan der Vlies CH, Olthof DC, Gaakeer M, Ponsen KJ, van Delden OM et al (2018) Changing patterns in diagnostic strategies and the treatment of blunt injury to solid abdominal organs. Int J Emerg Med 4: 47. Link: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/2179410\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/2179410\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCosta G, Tierno SM, Tomassini F, Venturini L, Frezza B et al (2017) The epidemiology and clinical evaluation of abdominal trauma. An analysis of a multidisciplinary trauma registry. Ann Ital Chir 81: 95\u0026ndash;102. Link: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bit.ly/3pkcB4l\u003c/span\u003e\u003cspan address=\"https://bit.ly/3pkcB4l\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRichardson JD (2017) Changes in the management of injuries to the liver and spleen. J Am Coll Surg 200: 648\u0026ndash;669. Link: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bit.ly/3AYANLU\u003c/span\u003e\u003cspan address=\"https://bit.ly/3AYANLU\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eForsythe RM, Harbrecht BG, Peitzman AB (2006) Blunt splenic trauma. Scand J Surg 95: 146\u0026thinsp;\u0026ndash;\u0026thinsp;51. Link: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://bit.ly/2Zg9hfU\u003c/span\u003e\u003cspan address=\"https://bit.ly/2Zg9hfU\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"61120cc9-716f-4e64-954b-a8589c915c2c","identifier":"10.13039/100016418","name":"B.K. Kee Foundation","awardNumber":"0996066591","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Syrian Private University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"spleen, blunt trauma, penetrating trauma, conservative treatment, surgical treatment","lastPublishedDoi":"10.21203/rs.3.rs-4817905/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4817905/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e Our study aims to study blunt and penetrating traumatic splenic injuries, their management methods (Surgical or conservative) and complications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A retrospective cohort study was conducted in the Department of Surgery at Damascus Hospital between 2015 and 2023. The study included all patients who suffered from penetrating and blunt traumatic splenic injury and were admitted to the surgery department. Data and information were tabulated using Excel spreadsheet program and then data were analyzed using SPSS-25. The results were compared with international studies according to mortality and morbidity rates perioperatively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The study included 98 patients (mean age 19.03 years with standard deviation 17.46 years, male and female ratio 71.4% and 28.6% respectively), 99% of blunt injuries, 1% of penetrating injuries, most of the injuries were grade IV (45.6% of 22 patients), most of the injuries were isolated (92.9%), 86% of stable patients (n=86) were treated surgically (91.9% excisional surgery, 8.1% conservative surgery), and 14% of them were treated conservatively, most of the unstable patients were treated surgically (91.7% excisional treatment, 8.3% conservative surgery), mortality rate 11.2% of all patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003econclusion:\u003c/strong\u003e Allocating a section in the emergency intensive care unit to follow up on patients with abdominal trauma, which is supervised and followed up by a specialized team that ensures close monitoring of the patient in the required manner, with the possibility of conducting radiological and laboratory investigations within this section at the required speed and at any time.\u003c/p\u003e","manuscriptTitle":"Management Of Spleen Trauma In Damascus Hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-30 07:16:11","doi":"10.21203/rs.3.rs-4817905/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0fb3c91c-cc24-4891-84f3-7ee49db26a2c","owner":[],"postedDate":"July 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":35240129,"name":"General Surgery"}],"tags":[],"updatedAt":"2024-07-30T07:16:11+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-30 07:16:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4817905","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4817905","identity":"rs-4817905","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}