Complications of Splenectomy: Etiology, Prevention, and Management

doi:10.1016/S0039-6109(16)43191-9

Surgical Clinics of North America

Volume 63, Issue 6, December 1983, Pages 1313-1330

https://doi.org/10.1016/S0039-6109(16)43191-9 Get rights and content

About 35,000 splenectomies are performed each year. Complications result from an interplay of technical factors, the disease for which splenectomy is performed, the associated surgical procedures, and possible associated injuries. Familiarity with the anatomic relationship of the spleen to other structures combined with meticulous operative technique will lower the morbidity and mortality associated with splenic surgery.

REFERENCES (88)

E.L. Francke et al.
Post splenectomy infections
Surg. Clin. North Am.
(1981)
J.F. Goldthorn et al.
Protective effect of residual systemic tissue after subtotal splenectomy
J. Pediatr. Surg.
(1978)
R.A. Hodam
The risk of splenectomy
Am. J. Surg.
(1970)
W. Krivit et al.
Overwhelming postsplenectomy infection
Surg. Clin. North Am.
(1979)
M.S. Mazel
Traumatic rupture of the spleen with special reference to its characteristics in young children
J. Pediatr.
(1945)
C. Mowah et al.
Post splenectomy fever
Trans. R. Soc. Trop. Med. Hyg.
(1974)
W.R. Olsen et al.
Wound drainage after splenectomy
Am. J. Surg.
(1969)
R. Sherman
Rationale for and methods of splenic preservation following trauma
Surg. Clin. North Am.
(1981)
J.I. Sullivan et al.
Immune response after splenectomy
Lancet
(1978)
J.A. Winkelstein et al.
Pneumococcal serum opsonizing activity in splenectomized children
J. Pediatr.
(1975)

P.C. Applebaum et al.

Fatal pneumococcal bacteremia in a vaccinated, splenectomized child

N. Engl. J. Med.

(1979)

D.C. Balfour

Surgery of the spleen

Collected Papers Mayo Clinic

(1917)

J. Balz et al.

Mesenteric thrombosis following splenectomy

Ann. Surg.

(1975)

N.W. Barker et al.

A statistical study of postoperative venous thrombosis and pulmonary embolism. I. Incidence in various types of operations

Mayo Clin. Proc.

(1940)

A.F. Barnes

Subcutaneous traumatic rupture of the normal spleen

Ann. Surg.

(1914)

W.R. Bell et al.

Guidelines for the use of thrombolytic agents

N. Engl. J. Med.

(1979)

P.D. Bostran et al.

Splenectomy: An eleven year review

Arch. Surg.

(1969)

M.A. Boxer et al.

Thromboembolic risk of post splenectomy thrombocytosis

Arch. Surg.

(1978)

I. Brodsky et al.

Platelet and fibrinogen kinetics in the chronic myeloproliferative disorders

Cancer

(1972)

P.J. Broe et al.

Thrombosis of the portal vein following splenectomy for myeloid metaplasia

Surg. Gynecol. Obstet.

(1981)

S.M. Bull et al.

Mesenteric venous thrombosis following splenectomy: Report of two cases

Ann. Surg.

(1968)

W.L. Burtain et al.

Splenorrhaphy: Changing concepts for the traumatized spleen

Surgery

(1979)

D. Bynk et al.

Postsplenectomy gastric perforation

Surgery

(1967)

J.M. Cardamane et al.

Abnormalities of platelet function in myeloproliferative disorders

J.A.M.A.

(1972)

E.J. Cerise et al.

Abdominal drains: Their role as a source of infection following splenectomy

Ann. Surg.

(1970)

C. Chaimolt et al.

Serum immunoglobulin changes after accidental splenectomy in adults

Am. J Surg.

(1978)

L.H. Cohn

Local infection after splenectomy

Arch. Surg.

(1965)

C. Coltheart et al.

Splenectomy: A review of morbidity

Aust. N. Z. J. Surg.

(1976)

D.R. Coney et al.

Relative merits of partial splenectomy: Splenic reimplantation and immunization in preventing postsplenectomy infection

Surgery

(1979)

W.W. Coon et al.

Deep venous thrombosis and postsplenectomy thrombocytosis

Arch. Surg.

(1978)

R.V. Dabao et al.

Splenectomy: Indications and complications

Am. Surg.

(1965)

D.N. Danforth et al.

Incidental splenectomy: A review of the literature and the New York Hospital experience

Ann. Surg.

(1976)

H.S. Daoud et al.

Complications following splenectomy

Arch. Surg.

(1966)

H.B. Delatour

Thrombosis of mesenteric vein as a cause of death after splenectomy

Am. Surg.

(1895)

J.D. Dickerman

Traumatic asplenism in adults: A defined hazard?

Arch. Surg.

(1981)

S.S. Donaldson

Characterization of post-splenectomy bacteremia among patients with and without lymphemia

N. Engl. J. Med.

(1972)

S.S. Donaldson et al.

Bacterial infection in pediatric Hodgkin’s disease: Relationship to radiotherapy, chemotherapy, and splenectomy

Cancer

(1978)

L. Drietzker

Rupture of the spleen: A report of 27 cases

Surg. Gynecol. Obstet.

(1930)

S.H. Ein et al.

The morbidity and mortality of splenectomy in childhood

Ann. Surg.

(1977)

B.C. Eisenberg

Splenectomy in children: A correlative review in location and complications in fifty patients

Am. J. Surg.

(1976)

E.H. Ellison et al.

Complications following splenectomy

A.J. Erakalis et al.

Splenectomy in childhood: A review of 1,413 cases

J. Pediatr. Surg.

(1972)

P.J. Fabri et al.

A quarter century with splenectomy

Arch. Surg.

(1974)

J.H. Gibbons

Rupture of the spleen (Discussion)

Ann. Surg.

(1908)

Cited by (194)

A case of giant primary splenic hydatid cyst: Case report
2022, Annals of Medicine and Surgery
Citation Excerpt :
Anaphylactic shock due to spontaneous or traumatic cyst rupture during surgery is a rare and severe complication [22]. Splenectomy is associated with sepsis-related death in 1.9% in adults and 4% in children [23]. Although the risk of infection has been reported to be highest in the first 2 years after splenectomy affecting mainly the young, no age is exempt as overwhelming sepsis has been reported more than 50 years after splenectomy [6].
Primary splenic hydatidosis is a rare zoonotic disease, common in grazing regions of the world. Primary splenic hydatid cyst is rare and accounts for <2% of patients. Splenectomy is advocated in case of giant hydatid cyst locating in central and hilum area; however, spleen salvaging operations are done in superficial cyst, cysts localized to one pole of the spleen or cysts that are unresectable due to extensive adhesions and in children.
We present a case of 29-year male patient from rural areas presented with the complain of left hypochondriac pain and tenderness along with the history of farming and cattle raising. There was no other significant history.
Physical examination showed mildly distended abdomen, mild tenderness over left hypochondrium. Routine laboratory investigations were sent. Ultrasound and CT scan of the abdomen showed giant splenic cyst measuring approx. 15 × 14 × 11 cm along with daughter cysts. Postoperatively, cyst was sent for histopathological examination.
Preoperatively, vaccinations against Pneumococcus, Hemophilus influenzae and Meningococcus along with Albendazole (15 mg/kg/day) was given 2 weeks before the planned operation. Total splenectomy was performed and diagnosis was confirmed by histopathological examination. Albendazole was continued for 2 more weeks. Patient remains asymptomatic thereafter and regularly followed up in OPD basis.
Presence of isolated splenic cyst should raise suspicion for primary splenic hydatid cyst in endemic areas. Splenectomy versus spleen salvaging options should be analyzed and performed as per the indications. Splenic hydatid cyst is one of the rare clinical findings and there is very much high chance that it goes undiagnosed during the clinical practice. So, the main motive behind writing this article is to shed knowledge on basic approach to this splenic finding.
Primary splenic hydatid cyst treated with laparoscopic spleen preserving surgery: A case report
2020, International Journal of Surgery Case Reports
Citation Excerpt :
Laparoscopic surgery has shown better results in previous studies, with significantly lower morbidity rates when compared to open technique [11]. Total splenectomy could lead to some dreadful comorbidities, most importantly an increased risk of overwhelming post-splenectomy infections (OPSI), which carries a mortality rate reaching 50% [12]. This has led to the rationale behind spleen preserving surgery, suggesting it as a better alternative to total splenectomy when feasible, since it could preserve the spleen's immunological role and reduce such risks.
Primary splenic hydatidosis is an uncommon etiology. Total splenectomy has been the treatment of choice, however, spleen preserving surgery has been gaining popularity.
We present a case of a 52-year-old man who was evaluated for a splenic cyst, found incidentally on CT scan done at another institution. MRI was repeated in our institution along with an indirect hemagglutination test to confirm the diagnosis. Since our patient had a single non-complicated cyst confined to the spleen’s lower pole, we decided to opt for laparoscopic cyst unroofing and omentoplasty, a spleen preserving technique.
Due to the rarity of splenic hydatidosis, no strict management guidelines are available, and the decision is usually left for the surgeon. Total splenectomy has been considered the standard of care, however, spleen preserving surgical techniques and percutaneous interventions have been suggested as better alternatives. Spleen preserving techniques lead to surgical outcomes comparable to total splenectomy, with the added benefit of preserving the immunological protection provided by the spleen and protecting patients from dramatic complications that might follow total splenectomy, such as overwhelming post-splenectomy infections, which are associated with very high mortality.
Laparoscopic cyst unroofing and omentoplasty is a feasible surgical technique to treat primary splenic hydatidosis while preserving the spleen’s immunologic function.
A Diagnostic Prediction Model of Acute Symptomatic Portal Vein Thrombosis
2019, Annals of Vascular Surgery
The aim of this study was to develop a diagnostic prediction model to improve identification of acute symptomatic portal vein thrombosis (PVT).
We examined 47 patients with PVT and 94 controls without PVT in the Second Affiliated Hospital of Soochow University and Suqian People's Hospital of Nanjing, Gulou Hospital Group. We constructed a prediction model by using a support vector machine (SVM) classifier coupled with a least absolute shrinkage and selection operator (LASSO). We applied a 10-fold cross-validation to estimate the error rate for each model.
The present study indicated that acute symptomatic PVT was associated with 11 indicators, including liver cirrhosis, D-Dimer, splenomegaly, splenectomy, inherited thrombophilia, ascetic fluid, history of abdominal surgery, bloating, C-reactive protein (CRP), albumin, and abdominal tenderness. The LASSO-SVM model achieved a sensitivity of 91.5% and a specificity of 100.0%.
We developed a LASSO-SVM model to diagnose PVT. We demonstrated that the model achieved a sensitivity of 91.5% and a specificity of 100.0%.
Pathogen clearance and immune adherence “revisited”: Immuno-regulatory roles for CRIg
2018, Seminars in Immunology
Rapid elimination of microbes from the bloodstream, along with the ability to mount an adaptive immune response, are essential for optimal host-defense. Kupffer cells are strategically positioned in the liver sinusoids and efficiently capture circulating microbes from the hepatic artery and portal vein, thus preventing bacterial dissemination. In vivo and in vitro studies have probed how complement receptor of the immunoglobulin superfamily (CRIg), also referred to as Z39Ig and V-set and Ig domain-containing 4 (VSIG4), acts as a critical player in pathogen recognition and clearance. While recent data suggested that CRIg may bind bacterial cell wall components directly, the single transmembrane receptor is best known for its interaction with complement C3 opsonization products on the microbial surface. On Kupffer cells, CRIg must capture opsonized microbes against the shear forces of the blood flow. In vivo work reveals how immune adherence (IA), a process in which blood platelets or erythrocytes associate with circulating bacteria, plays a critical role in regulating pathogen capture by CRIg under flow conditions. In addition to its typical innate immune functions, CRIg was shown to directly and indirectly influence adaptive immune responses. Here, we review our current understanding of the diverse roles of CRIg in pathogen elimination, anti-microbial immunity and autoimmunity. In particular, we will explore how, through selective capturing by CRIg, an important balance is achieved between the immunological and clearance functions of liver and spleen.
Spleen and Liver
2018, Equine Surgery, Fifth Edition
Long-term infectious risks after splenectomy: A retrospective cohort study with up to 10 years follow-up
2017, Revue de Medecine Interne
L’incidence des infections après splénectomie est mal établie sur le long terme. L’objectif de cette étude est de décrire les complications infectieuses et les facteurs associés à la survenue d’une complication infectieuse chez les patients ayant bénéficié d’une splénectomie depuis plus de dix ans.
Étude rétrospective monocentrique de patients adultes splénectomisés entre le 1^er janvier 1997 et le 31 décembre 2004 dans un centre hospitalier universitaire. Les données sur l’âge, le sexe, l’indication de la splénectomie, les événements infectieux, la mortalité, le statut vaccinal et l’antibioprophylaxie ont été collectées en janvier 2015.
Cent soixante-cinq patients ont été inclus. Les hémopathies malignes représentent l’indication principale de la splénectomie (37,5 %). Quatre-vingt-dix-sept pour cent des patients ont bénéficié d’une vaccination contre le pneumocoque. Soixante-dix-huit pour cent ont reçu une antibioprophylaxie dont les modalités sont hétérogènes. Trente-sept patients ont présenté 42 complications infectieuses survenant en médiane 4 ans après la splénectomie (2 jours à 12 ans). Cinquante-sept pour cent des infections sont survenues au-delà de la 2^e année, et 14,3 % au-delà de la 10^e année. Il s’agit majoritairement d’infections pulmonaires et/ou microbiologiquement documentées à pneumocoque. La survenue d’une complication infectieuse est liée significativement à l’âge (HR = 6,2 ; IC95 % : 1,4–27,1 ; après 65 et à la cause de la splénectomie [p = 0,002]). Les différentes modalités de prescription de l’antibioprophylaxie ne sont pas significativement associées à la survenue d’infection.
Après splénectomie, le risque infectieux persiste au long cours avec d’authentiques infections à germes encapsulés survenant parfois après plus de 10 ans. La survenue d’une complication infectieuse est liée à l’âge et à la cause de la splénectomie.
Although most infections occur within the first 2 years after splenectomy, the relatively short follow-up reported in many studies may underestimate the frequency of infections. The objective of the study was to determine the incidence of infective outcomes and factors associated with infection after splenectomy by studying a group of patients who underwent splenectomy over a 10-year period.
A retrospective and monocentric study of patients who underwent splenectomy between January 1st, 1997 and December 31st, 2004 in a French university hospital. Age, sex, indication for splenectomy, infectious events, death, vaccination and antibiotic prophylaxis were collected in January 2015.
One hundred and sixty-five patients were included. The most common reasons for splenectomy were therapeutic hematological indications (37.5%). Ninety-seven per cent received pneumococcal vaccine. Prophylactic antibiotics were prescribed in 78% of patients. Thirty-seven patients had 42 severe infections with a median incidence rate of 4 years after splenectomy (2 days–12 years). The rate of infection after splenectomy declined over time but 57% occurred after 2 years and 14.3% after 10 years. Respiratory infections were the most common sites of infections. The incidence of infection differed according to age was highest among the elderly (HR = 6.2; 95%CI: 1.4–27.1; after 65 years old) and underlying reason for splenectomy (P = 0.02). There is no difference with or without prophylactic antibiotics.
After splenectomy, the incidence of severe infection declined over time but can occur after 10 years. The onset of infection is linked to age and reason for splenectomy.

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: From the Department of Surgery, The Ohio State University College of Medicine, Columbus, Ohio

: Department of Surgery, Ohio State University, 410 West 10th Avenue, Columbus, OH 43210

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Complications of Splenectomy: Etiology, Prevention, and Management

Surg. Clin. North Am.

J. Pediatr. Surg.

Am. J. Surg.

Surg. Clin. North Am.

J. Pediatr.

Trans. R. Soc. Trop. Med. Hyg.

Am. J. Surg.

Surg. Clin. North Am.

Lancet

J. Pediatr.

Fatal pneumococcal bacteremia in a vaccinated, splenectomized child

N. Engl. J. Med.

Surgery of the spleen

Collected Papers Mayo Clinic

Mesenteric thrombosis following splenectomy

Ann. Surg.

A statistical study of postoperative venous thrombosis and pulmonary embolism. I. Incidence in various types of operations

Mayo Clin. Proc.

Subcutaneous traumatic rupture of the normal spleen

Ann. Surg.

Guidelines for the use of thrombolytic agents

N. Engl. J. Med.

Splenectomy: An eleven year review

Arch. Surg.

Thromboembolic risk of post splenectomy thrombocytosis

Arch. Surg.

Platelet and fibrinogen kinetics in the chronic myeloproliferative disorders

Cancer

Thrombosis of the portal vein following splenectomy for myeloid metaplasia

Surg. Gynecol. Obstet.

Mesenteric venous thrombosis following splenectomy: Report of two cases

Ann. Surg.

Splenorrhaphy: Changing concepts for the traumatized spleen

Surgery

Postsplenectomy gastric perforation

Surgery

Abnormalities of platelet function in myeloproliferative disorders

J.A.M.A.

Abdominal drains: Their role as a source of infection following splenectomy

Ann. Surg.

Serum immunoglobulin changes after accidental splenectomy in adults

Am. J Surg.

Local infection after splenectomy

Arch. Surg.

Splenectomy: A review of morbidity

Aust. N. Z. J. Surg.

Relative merits of partial splenectomy: Splenic reimplantation and immunization in preventing postsplenectomy infection

Surgery

Deep venous thrombosis and postsplenectomy thrombocytosis

Arch. Surg.

Splenectomy: Indications and complications

Am. Surg.

Incidental splenectomy: A review of the literature and the New York Hospital experience

Ann. Surg.

Complications following splenectomy

Arch. Surg.

Thrombosis of mesenteric vein as a cause of death after splenectomy

Am. Surg.

Traumatic asplenism in adults: A defined hazard?

Arch. Surg.

Characterization of post-splenectomy bacteremia among patients with and without lymphemia

N. Engl. J. Med.

Bacterial infection in pediatric Hodgkin’s disease: Relationship to radiotherapy, chemotherapy, and splenectomy

Cancer

Rupture of the spleen: A report of 27 cases

Surg. Gynecol. Obstet.

The morbidity and mortality of splenectomy in childhood

Ann. Surg.

Splenectomy in children: A correlative review in location and complications in fifty patients

Am. J. Surg.

Complications following splenectomy

Splenectomy in childhood: A review of 1,413 cases

J. Pediatr. Surg.

A quarter century with splenectomy

Arch. Surg.

Rupture of the spleen (Discussion)

Ann. Surg.