Emergency Laparoscopic Splenectomy for Splenic Trauma in a Jehovah's Witness Patient

Abstract

The safety and efficacy of laparoscopic splenectomy in the management of benign hematologic diseases is well established. However, most consider the laparoscopic approach to splenectomy in trauma patients contraindicated. We present a 76-year-old Jehovah's Witness who sustained a blunt abdominal trauma, rib fractures, and grade III splenic injury. She continued to lose blood, albeit slowly, for which she underwent preemptive urgent laparoscopic splenectomy with the use of the red cell saver. The operating time was 65 minutes. She was discharged on the 16th postoperative day after recovering from fractured ribs with subsequent pulmonary atelectasis and basal pneumonia. Whereas the majority of grade I to III splenic injuries in adults can be managed conservatively, some 20% will fail and require emergency splenectomy for delayed rupture of the spleen. In a Jehovah's Witness patient, early splenectomy for injury with the use of red cell saver is advised. This may be accomplished laparoscopically in the hemodynamically noncompromised patient.

Emergency Subtotal Colectomy in a Jehovah’s Witness With Massive Lower Gastrointestinal Bleeding: Challenges Encountered and Lessons Learned

“…For trauma patients who are Jehovah's Witnesses, some authors 4 have advised early operative intervention in conditions that would otherwise be managed nonoperatively. Exsanguinating Jehovah's Witnesses have a low hemodynamic reserve, so early intervention is often beneficial.…”

Laparoscopy in Abdominal Trauma

“…As stated before, laparoscopy in trauma can be used for diagnosis and therapy in several indications, both in blunt and penetrating trauma: As far as splenic injuries are concerned, the literature only mentions case reports of laparoscopic splenectomy and mesh splenorrhaphy; therefore, these operations are not supported by sound data [64][65][66][67]. From our point of view, splenic injuries are not an indication for laparoscopy for the following reasons: (I) stable patients with a splenic injury should undergo NOM and do not require surgery.…”

Management of acutely bleeding patients who refuse blood transfusion

“…Postoperative drains may also be acceptable to many if the device is not disconnected from the patient. Close monitoring of abdominal injuries with early intervention including laparoscopic splenectomy should be considered [33]. In general, staged surgical procedures that result in less blood loss per procedure are preferable to larger procedures that will result in more significant blood loss [21].…”