Partial splenectomy in the management of blunt splenic trauma

Hamdy S Abd Allah, PhD. Gastrointestinal Surgery Unit, General Surgery Department, Faculty Of Medicine, Tanta University.

Background: A ruptured spleen caused by blunt abdominal injury was often treated by splenectomy. Overwhelming post-splenectomy infection occurs in 1.4% of all such cases and the mortality is about 50-80%. There is a hard evidence to support the concept that the immune function of the spleen is present after preservation of part of the splenic tissue.

Patients and methods: The files of all patients treated by partial splenectomy for blunt splenic injury in Gastrointestinal Surgery Unit, Tanta University Hospital during the period from January 2009 to January 2012, were reviewed.

Results: Examination of the patient’s files revealed that 83 patients had surgery for blunt splenic injury during the reported time, 25 of them (30%) had partial splenectomy and a total of 22 files were analyzed. The mean age was 27 years (range 9–43). Seventeen patients presented after road traffic accidents (77%). At laparotomy, active bleeding from the spleen was found in 21 patients (95%). Associated intra-abdominal injuries were found in 9 patients (41%). The operative time of partial splenectomy ranged from 80-130 minutes with a mean of 110 minutes. None of the patients developed post-operative bleeding or other complications specific to the surgical procedure. Overall, postoperative complications were diagnosed in 6 patients. The hospital stay ranged from 7-21 days with a mean of 9.5 days. Postoperatively, all of the tested patients showed normal platelet count and normal clearance of Howell-Jolly bodies and CT scan showed normal vascularized splenic remnant in tested patients.

Conclusion: In patients with blunt splenic injury, in the absence of other associated life threatening injuries, splenic salvage must always be attempted. Based on the anatomy of the injury, partial splenectomy with preservation of, at least, one third of the spleen is safe and maintains normal filtering function of the spleen.

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