Splenectomy in a Nigerian Teaching Hospital: A comparison of sonographic correlation with intra-operative findings in trauma

BACKGROUND: Missed or inappropriately-treated splenic injury is a significant cause of preventable trauma-related death. Physical examination and abdominal ultrasonography are essential tools for early diagnosis of splenic injury. However, some injuries may not be accurately diagnosed by ultrasonography at initial evaluation. AIM: The aim of this study was to audit indications for splenectomy at the University College Hospital, Ibadan and to compare the intra-operative findings in trauma-related cases with the sonographic findings. MATERIALS AND METHODS: We retrospectively reviewed all adult (12 years and older) patients’ records who had splenectomy between July 2003 and June 2010. The data extracted included patient demographics and indications for splenectomy. In trauma cases, the mode of injury and vital signs at presentation, sonographic findings, and operation findings were recorded. The intervals between injury and sonography and duration to surgery were also noted respectively. RESULTS: Eighty-four patients were reviewed in the 7-year review period. The male to female ratio was approximately 2:1. The ages ranged from 14 to 76 years with a peak incidence in the third decade. Elective indications for splenectomy were 14 (16.6%), while 70 (83.3%) were emergency cases. Forty-four of the trauma-related patients had pre-operative abdominal ultrasound, of which 31 (70%) was reported as sonographically normal prior to surgery, while the rest of the trauma-related cases were considered too ill for ultrasonography. CONCLUSION: Potentially significant injuries may be missed with screening sonography. For this reason, a physician must maintain a high index of suspicion and consider the patient's clinical status or an alternative imaging modality in excluding a diagnosis of splenic injury.