Splenic trauma

Background: Intraabdominal organ injuries are sustained by 40 to 50% of polytraumatized patients. The spleen is most commonly affected. While 95% of pediatric cases will not require surgery, this is the case with only 5 to 10% of adults. Methods: Organ preservation is desirable, even in emergency cases with splenic rupture. Of the techniques available for this purpose, tissue adhesives, coagulation, partial resection and mesh splenorrhapy are the most suitable. Results: Tissue adhesives are commonly used with success for superficial lacerations. Coagulation techniques are also suitable for organ conservation in grade I and II injuries. Splenorrhaphy with resorbable mesh is the method of choice in third degree bursting ruptures as it permits rapid and permanent hemostasis. If injury only involves one pole or one half of the spleen, resection of that part of the organ is an option. Partial resection is best performed with a stapler using absorbable staples. Total fragmentation or separation of the hilus is treated with immediate splenectomy, sparing the tail of the pancreas. Conclusions: Splenectomized patients should be immunized with pneumococcus and influenza vaccine and informed of their immune defect.