Malign effects of splenectomy—the place of conservative treatment

Abstract

In this review article the incidence is discussed of overwhelming post-splenectomy infection (OPSI), which is especially likely to occur in children and when splenectomy is carried out for haematological disorders. Long-term broad spectrum antibiotics or the use of polyvalent pneumococcal vaccine are often advocated as prophylactic measures under these circumstances. After mild splenic trauma, conservative surgery or partial splenectomy may be indicated in some cases. Where trauma is more severe and the spleen cannot safely be preserved there may be a place for autotransplantation of splenic slices, for example into a pocket of omentum, and there is some experimental support for this technique.

The Complete Spleen

“…(1978) have reported encouraging results with respect to partial splenectomy during staging laparotomy of patients with Hodgkin's disease and found no evidence that evaluation of splenic involvement was compromised. There is still a pressing need for further data, to assess the indications for partial splenectomy in this and other hematological diseases, and to partial splenectomy and repair of the spleen (splenorrhaphy) in other situations, such as splenic rupture and lacerations, commonly treated by total splenectomy (Werbin and Lodha, 1982). There is an increasing trend toward both nonoperative management and splenorrhaphy in surgical centers around the world (Jalovec etal., 1993;Mustafa, 1994;Van Etten et al, 1995;Garber, 1996).…”