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The overwhelming postsplenectomy sepsis problem

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Abstract

Postsplenectomy vulnerability to infection is not limited to age or disease process. Postsplenectomy infection is an emergency problem that requires immediate and accurate treatment because death is potential within a few hours of onset. Although the pathogenesis of overwhelming postsplenectomy sepsis is not completely understood, experimental evidence suggests that loss of mechanical filtration is more important than immunologic deficiences resulting from splenectomy. Certainly, a combination of both may be present. While no single measure seems to completely protect against overwhelming postsplenectomy sepsis, experimental evidence suggests that by reducing or minimizing the amount of spleen removed by newer surgical techniques, and by the addition of pneumococcal vaccine and prophylactic penicillin, the incidence of overwhelming sepsis can be reduced. Further evaluation of splenic function is necessary to assess the role of autotransplantation in the prevention of postsplenectomy sepsis (Fig. 1).

Résumé

La vulnérabilité à l’infection après splénectomie ne dépend ni de l’âge, ni de la maladie originelle. Toute infection survenant après splénectomie est une urgence qui peut tuer en quelques heures: elle exige donc un traitement immédiat et adéquat. La pathogénie est encore mal précisée. Des données expérimentales suggèrent que la perte du mécanisme de filtration splénique est plus importante que le déficit immunologique, ces deux facteurs pouvant cependant coexister. Il est apparemment impossible d’assurer une protection parfaite contre les infections graves après splénectomie. Mais certaines études expérimentales indiquent qu’on peut en réduire la fréquence par les nouvelles techniques chirurgicales qui évitent la splénectomie totale, par la vaccination antipneumococcique et par l’administration préventive de pénicilline. Lorsque les fonctions de la rate seront mieux connues, il sera possible de préciser le rôle prophylactique de l’autotransplantation splénique.

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Authors and Affiliations

  1. Departments of Surgery and Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA

    Arnold S. Leonard M.D., Ph.D., G. Scott Giebink M.D., Thomas J. Baesl M.D. & William Krivit M.D., Ph.D.

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  1. Arnold S. Leonard M.D., Ph.D.
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  2. G. Scott Giebink M.D.
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  3. Thomas J. Baesl M.D.
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  4. William Krivit M.D., Ph.D.
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Leonard, A.S., Giebink, G.S., Baesl, T.J. et al. The overwhelming postsplenectomy sepsis problem. World J. Surg. 4, 423–427 (1980). https://doi.org/10.1007/BF02393164

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