RT Book, Section
A1 Ellison, E. Christopher
A1 Zollinger, Jr., Robert M.
A1 Pawlik, Timothy M.
A1 Vaccaro, Patrick S.
A1 Bitans, Marita
A1 Baker, Anthony S.
SR Print(0)
ID 1187822757
T1 Splenic Conservation
T2 Zollinger’s Atlas of Surgical Operations, 11e
YR 2022
FD 2022
PB McGraw-Hill Education
PP New York, NY
SN 9781260440850
LK accesssurgery.mhmedical.com/content.aspx?aid=1187822757
RD 2024/04/19
AB Injury  to  the  spleen  is  one  of  the  more  serious  problems  associated  with  trauma.  Serious  splenic  injury  can  lead  to  emergent  possible  exsanguination.  Splenectomy,  however,  confers  a  small  but  measurable  risk  of  catastrophic  bacterial  infection  with  encapsulated  organisms  such  as  pneumococci,  especially  in  children,  for  the  remainder  of  the  patient’s  life.  This  risk  has  stimulated  clinicians  to  conserve  the  spleen  with  or  without  operation.  Nonoperative  treatment  in  children  and  adults  is  often  successful  if  careful  monitoring  is  provided  in  hospital  and  thereafter  at  home  until  full  healing  is  documented.  In  addition,  angiographic  embolization  may  be  used  to  control  splenic  bleeding.  In  adults  as  well  as  in  children,  splenorrhaphy  is  often  possible  because  it  is  desirable  to  salvage  as  much  of  the  traumatized  spleen  as  possible.  It  is  uncertain  how  much  retained  spleen  is  essential  to  provide  normal  protection  for  patients,  but  many  surgeons  recommend  preservation  of  half  or  more  if  possible.  The  surgeon  must  appreciate  that  it  is  essential  to  control  exsanguination  and  that  total  splenectomy  should  be  performed  for  splenic  fractures  that  are  massive  or  that  cannot  be  easily  controlled  in  the  presence  of  continued  major  hemorrhage.