الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Trauma is one of the main causes of death among individuals under 40 years old particularly due to the increasing the numbers of motor vehicle crashes and urban violence. Splenic trauma represents approximately 5% of admissions to emergency departments with significant morbidity and mortality.Splenic parenchyma and its vasculature are fragile and very susceptible to blunt and penetrating trauma, which makes the spleen the most frequently injured abdominal organ. Splenic injuries can be treated with either operative or conservative methods. The present study aimed to compare non-operative and operative management of traumatic splenic injuries in terms of incidence, efficacy, and safety.The present study is a retrospective study of prospectively maintained data of patients with splenic trauma admitted to Mansoura University Emergency hospital between January 2011 and February 2017.The following parameters were analyzed: Patients’ demographic data, mechanism of injury: blunt versus penetrating, vital signs and hemodynamic stability of patients on admission, presence of associated extra-splenic abdominal injuries, AAST-OIS grade of injury, management: non-operative management versus Surgical management, details of operative intervention, length of hospital stay, complications related the splenic trauma, and inpatient mortality rate.The majority of splenic injuries in the present study were of low grade (I-III) that were mostly managed in a conservative manner whereas higher injury grades were managed surgically. The surgical management group had longer hospital stay than the non-operative group, however the complications rate was comparable in both group. Recurrent bleeding was the most common complication in the conservative groups whereas intra-abdominal infection was the most common morbidity in the operative group. Failure of conservative treatment was observed in 35% of patients in the non-operative group. Six mortalities were recorded; all were in the operative group.Conclusion: The Management of splenic trauma should be dependent on two main factors; hemodynamic stability and presence of clinical signs of peritonitis as recorded by international guidelines. CT scanning of splenic injury is feasible and recommended; provided that the patient is fulfill the criteria for conservative management. High failure rates of conservative treatment in the present study is mostly attributed to associated extra-abdominal injuries, increased ISS decreased HB level, decreased platelet count and increased WBCS count.