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CONSERVATIVE TREATMENT OF DAMAGE TO THE SPLEN DURING CLOSED ABDOMINAL TRAUMA Mustafakulov Ishnazar Boynazarovich
Doctor of Medical Sciences, Professor of the Department of Surgical Diseases No. 2, Samarkand State Medical University; https://doi.org/10.5281/zenodo.12798203
ARTICLE INFO
ABSTRACT
Received: 17th July 2024 Accepted: 22th July 2024 Online: 23th July 2024 KEYWORDS
Hematopoiesis, immune status, hemostasis system, fibrinogen increases,
inhibited, thrombotic complications.
The spleen has a number of important functions, the main of which are participation in hematopoiesis, the immune status of the body and an important role in the hemostasis system [2, 5, 13, 18, 24]. In particular, after splenectomy there is a change in the main indicators of the vascular-platelet component of hemostasis: an increase in the number of platelets and their functional activity, including adhesive ability, the reaction of release of platelet factors is disrupted, and the retraction index decreases [7, 21]. Changes can also be traced in the coagulation link of the hemostasis system: the activated partial thromboplastin time is shortened, the concentration of fibrinogen increases, and fibrinolysis is inhibited. All this leads to the development of thrombotic complications [8,14,19, 26].
The participation of the spleen in the immune status of the body has been proven. The spleen belongs to the peripheral lymphoid organs [3, 4]. Suppressor and helper lymphocytes and some effector cells are concentrated in it, as well as the process of active antibody formation and the production of humoral mediators of immunity [4]. The spleen contains approximately 35% T lymphocytes and about 65% B lymphocytes [3, 6, 15, 20]. Both stages of differentiation of antibody-forming cells from bone marrow precursors occur in it, while for T lymphocytes the antigen-independent stage of differentiation from bone marrow precursors occurs in the thymus, and the antigen-dependent stage in the spleen [10, 16, 21, 27]. The complex structure of the lymphatic follicles of the spleen, including thymus-dependent, thymus-independent and macrophage elements, creates favorable conditions in the organ for the cooperation of cells in the immune response [1, 6, 17, 22]. There is no doubt that removal of the spleen leads to a change in the immune status of the body and the development of infectious complications, especially those caused by opportunistic microflora.
In addition, splenectomy leads to the development of severe purulent-septic complications, both in the immediate and late postoperative period. It is known that in the immediate postoperative period after splenectomy, the number of postoperative complications reaches 30% [12, 18, 25]. In this case, the mortality rate is 16-30% [11].
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In order to prevent the development of complications and preserve the main functions of the organ, various types of organ-preserving operations are currently proposed; if their use is impossible, autologous transplantation of fragments of the damaged spleen is proposed [9, 27]. Currently, with the development and improvement of laparoscopic technology and visualization equipment, a new opportunity has emerged in the diagnosis and conservative treatment of spleen injuries. But the paucity of works in the periodical literature devoted to the study of non-operative treatment of spleen injuries to preserve the organ urgently requires scientific research in this direction. In hemodynamically stable patients with blunt spleen injuries, conservative management is becoming the standard of care. As the spleen is a common organ injured by blunt abdominal trauma, splenectomy is usually carried out to prevent hemorrhagic shock. Due to the immune functions of the spleen, infections like post-splenectomy sepsis, malaria, and pneumonia can occur after a splenectomy [1]. Conservative treatment of splenic injury and other abdominal organs has become increasingly popular in recent decades [2]. Conservative management achieved good results in 80-90% of cases, and it is currently considered the primary treatment for spleen injuries in most centers, but there is no uniform protocol for this [3]. Arterial embolization in non-operative management of splenic trauma has been found and reported even after 8 hours of the injury. Conservative treatment has a success rate exceeding 90% and a failure rate as low as 8%, according to the literature [4,5]. As an important part of our immune system, the spleen filters and captures macrophages and cellular and non-cellular material such as pneumococcus, other bacteria, and red blood cells from the blood and plasma. A spleen should be salvaged because septicemia, opportunistic post-splenectomy infections, and malaria can occur after a splenectomy [1,6]. In blunt abdominal trauma, the physical examination and laboratory data are not specific for splenic injury [7]. A CT scan is important in this situation [8]. This study sought to determine the outcome and success rate of conservative management of splenic injury in blunt abdominal trauma.
The purpose of the study. There was an improvement in the results of complex treatment for injuries of the spleen due to closed abdominal trauma.
Material and methods. We observed 25 patients with spleen damage due to concomitant abdominal trauma, who underwent conservative hemostatic therapy. They were combined with trauma to the skull in 8 (32.0%) cases, chest - in 10 (40.0%), pelvis and limbs - in 7 (28.0%) cases. Of these, there were 19 (76.0) men, 6 (24.0) women, the average age was 29.5±1.5 years. The causes of combined splenic injury were: a fall from a height - in 13 (52.0%) patients, a car injury - in 12 (48.0%) patients. Duration of hospitalization of patients with spleen injury from the moment of injury: up to 1 hour - 18 (72.0%), from 1 to 3 hours - 7 (28%) victims.
The main criterion for choosing conservative treatment of patients was the presence of stable hemodynamics. Upon admission, in addition to clinical examination, all patients underwent dynamic ultrasound every 6-8 hours, multislice computed tomography (MSCT) of the abdominal cavity, a plain radiograph of the abdominal cavity and other anatomical areas by localization, a general blood and urine test, and a coagulogram.
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