Splenic Preservation following Splenic Trauma

Blunt Trauma to the Spleen

“…Overwhelming post‐splenectomy sepsis is a well‐recognized phenomenon, with a mortality rate of 50–80%. 5,16 The exact incidence of OPSI following splenectomy for trauma in adults is unclear, but it appears to be up to 6%, 3,5,7,8,16–18 with a lifetime risk of death of 0.025%. 7 Reduction in the risks of OPSI has proven to be a difficult goal to achieve.…”

“…There is no doubt that preservation of the spleen is the preferable outcome, given the small but definite incidence of overwhelming post‐splenectomy sepsis (OPSI). 1–8 However, the avoidance of splenectomy, either by non‐operative management or splenic conservation, is an avenue of treatment requiring careful risk–benefit analysis in the face of potentially life‐threatening haemorrhage from an injured spleen left in situ , and the possibility of transfusion‐induced viral infections.…”

Visceral and Renal Angiography

“…However, because of the spleen's important immunologic and hematologic function, trauma surgeons have in recent years been attempting to preserve splenic function by performing splenorrhaphy or partial splenectomy. 83 Angiographic occlusion of the splenic artery with coil-spring occluders is equally effective in achieving similar results. Splenic arterial occlusion decreases arterial inflow and blood pressure at the bleeding site, allowing a stable clot to form at the site of injury.…”

Use of fibrin glue (Tissucol) as a hemostatic in laparoscopic conservative treatment of spleen trauma

“…If progressive blood loss rules out any conservative approach, an organ-preserving procedure is preferable because it avoids severe late infections [6,26,28] or early postsplenectomy sepsis, which carries a 78% mortality rate [18].…”

“…A rapid and accurate hemostasis can be achieved also for patients lacking clotting factors or platelets [6,18,26,28] or taking anticlotting medications [15,16].…”