Splenic Injuries

Abstract

The treatment of splenic injury has changed over the past decade from prompt splenectomy in all cases to splenic salvage when possible. The most important factor influencing this change is the recognition of the risk of infection after splenectomy. As patients with severe splenic injury generally have other organ injuries, have lost a lot of blood, and are usually in shock, preservation of the spleen should not take significantly more time and require more blood than would a splenectomy. In both splenic salvage and splenectomy, the first step is identical: complete mobilization of the spleen and rotation onto the abdominal wall. Only in this position it is possible to make the right decision as to saving or removing the spleen. For splenic preservation, the choice of procedure depends not only on the clinical findings but also on the surgeon’s experience in splenic surgery and the equipment available at the particular hospital. In elderly patients, the concept of splenic salvage should be used with judgment and care. The best course with severe injuries is splenorrhaphy with an absorbable mesh, which quickly and effectively stops the bleeding. Second-, third-, and some fourth-degree injuries involving only one pole of the spleen can be treated with partial stapler resection. Stapling is simple to do, the instruments are practical, and it helps to reduce the operating time and blood transfusion. The most common complications or aftereffects of splenectomy are infections, which should receive standard treatment. The most dreaded complication after splenectomy is postsplenectomy sepsis. Splenectomized patients should be informed of the defect in their immune system and encouraged to keep their pneumococcus immunizations current.