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DIAGNOSTICS AND SURGICAL TACTICS IN TRAUMATIC INJURIES
OF THE SPLEEN.
Xakimov M.Sh.
Jumanazarov A.U.
Ismailova U.A.
Aripov Sh.Sh.
Tashkent Medical Academy
https://doi.org/10.5281/zenodo.15186664
Traumatic injuries of the spleen account for 15 to 35% of all injuries to
abdominal organs. Methods of treating the spleen are still controversial, since
the important role of this organ in the div's immunological defense has been
proven recently. There are reports of severe infectious diseases, often with a
fulminant course, in patients who have previously undergone splenectomy.
Research material.
Over the past two years, we have observed 42 patients
in the emergency surgery department of the multidisciplinary clinic of the
Tashkent Medical Academy, including 26 (61.9%) men and 16 (38.1%) women
aged 19 to 66 years. 85% of patients were aged 30 to 50 years. In 14 (33.3%)
patients, the injuries were open, in 28 (66.6%) - closed. The clinical picture was
often unclear, especially in case of combined trauma of the abdominal organs. All
patients with closed injuries underwent a comprehensive examination (general
blood and urine tests, ultrasound of the abdominal cavity, if necessary - plain
fluoroscopy of the abdominal organs) during which the nature and size of the
injury, the volume of blood loss were determined. Further tactics of patient
management, as a rule, depended on the size of the hemoperitoneum. In unclear
cases, diagnostic laparoscopy was performed in 12 (28.5%) patients to clarify
the diagnosis. Currently, we adhere to the principles of organ-preserving
operations for spleen ruptures. At the same time, it is not always possible to
perform organ-preserving operations, since the proportion of severe injuries is
quite high.
Research results.
We believe that absolute indications for splenectomy are
damage to the vessels of the splenic pedicle, crushing of the spleen, ruptures in
the hilum area and persistent bleeding. Splenectomy was performed in 26
patients. In 9 cases, the removed splenic tissue was implanted into the greater
omentum. In case of ruptures and small wound sizes, splenic wound suturing
with tamponade with a part of the greater omentum on the feeding pedicle was
performed in 6 patients, electrocoagulation of the wound surface was used in 8
patients and a hemostatic sponge was used in 2 patients.
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Conclusion
. If a closed splenic injury is suspected, ultrasound and
diagnostic laparoscopy should be the diagnostic standard. Whenever possible,
preference should be given to organ-preserving operations
