Non-Operative Management of Splenic Injuries (NOMSI) in a Limited Resources Setup

Abstract

Introduction: Gadarif is an endemic area of medical disorders causing splenomegaly in patients who are also subjected to abdominal trauma. Despite the lack of resources, which make adherence to the international guidelines of NOMSI somehow difficult, we apply it based on clinical evaluation, laboratory tests and ultrasound. Objectives: To study the outcome of NOMSI based on hemodynamic stability, ultrasound findings and follow-up. Methods: A prospective analytic hospital based study conducted in Gadarif, Eastern Sudan from 2015 to 2019, including patients who were having splenic injury with no clear indication for immediate surgery. Results: A total of 30 patients were included, of them 29 (96.7%) were male. Their age ranges between 7-65 years with the mean of 29.8. Twenty patients (66.7%) presented within 24 hours from trauma, while the rest presented later. Three patients (10%) had no history of abdominal trauma, one is an epileptic and the other 2 had concomitant severe malaria. Hemodynamic instability at presentation was found in 14 patients (46.7 %). Left hypochondrial pain was the predominant symptom in 20 patients (66.7 %) and two thirds of patients had tender LHQ. More than half (53.3%) had splenic hematoma/laceration on initial ultrasound. We encountered 5 (16.6%) patients with pathological spleens of Malaria or Visceral Leishmaniasis (Kala-azar). Four patients (13.3%), of those who had increased spleen size on initial US scan, were hemodynamically unstable and required emergency splenectomy resulting in a success rate of NOMSI in 86.7%. Conclusion: NOMSI based on clinical judgment and ultrasound examination in limited resources setup, is feasible and applicable with comparable success rates. Further studies are needed to evaluate NOMSI in endemic areas with pathological spleen.