Splenic lacerations: a retrospective analysis of management strategies and clinical outcomes.

Abstract

Background: Splenic injuries are among the most frequently encountered conditions in abdominal trauma. In such cases, the treatment approach must be carefully determined based on the patient's hemodynamic stability, the severity of the injury, and the presence of associated intra-abdominal pathologies, typically requiring a choice between non-operative management (NOM) and surgical intervention. The decision-making process is primarily guided by hemodynamic status, injury grade, and imaging findings. This study evaluates clinical outcomes and the factors influencing treatment decisions in patients with splenic rupture who were referred from the emergency department to the general surgery unit.

Methods: A retrospective cohort study was conducted on 42 patients diagnosed with splenic injury between June 2023 and February 2025. Patients were divided into two groups: those who received NOM (n=29, 69.0%) and those who underwent operative management (OM) (n=13, 31.0%). Demographics, mechanisms of injury, hemodynamic status, laboratory results, imaging findings, transfusion requirements, length of hospital stay, and mortality rates were analyzed. Statistical comparisons were made using appropriate tests, with significance set at p<0.05.

Results: The mean age of patients was 38.3±19.4 years, with 76.2% being male. The leading cause of injury was vehicular accidents (47.6%), followed by falls (21.4%) and penetrating trauma (11.9%). Operative management was more common in sharp object penetrating injuries (SOPI) (15.4%) and gunshot wounds (7.7%). Hemodynamic instability was more frequent in the OM group compared to the NOM group (30.8% vs. 10.3%, p=0.149). Splenectomy was performed in 76.9% of surgical cases (p=0.003). Computed tomography (CT) imaging revealed that Grade 1 injuries (55.2%) were predominant in the NOM group, while Grade 2 injuries (38.5%) were more common in the OM group (p=0.531). The OM group required more blood transfusions (2.6±3.0 units vs. 0.9±1.9 units, p=0.053) and had longer hospital stays (10.3±6.9 days vs. 5.7±4.9 days, p=0.042). Overall mortality was low (9.5%), with no significant difference between the groups (p=0.819).

Conclusion: Non-operative management is the preferred approach for hemodynamically stable patients, offering favorable outcomes and shorter hospital stays. However, penetrating trauma and hemodynamic instability are strong predictors for surgical intervention. Early risk stratification and close clinical monitoring are essential in determining the most appropriate treatment strategy for splenic injuries.