J.Jpn. Surg. Soc.
ISSN 1880-1129

[Abstract] [Full Text PDF] （in Japanese / 481KB） [Members Only And Two Factor Auth.]

J.Jpn. Surg. Soc.. 93(2): 177-182, 1992

Original article

OPERATIVE RISK OF SPLENIC REPAIR FOR ISOLATED BUT COMPLEX SPLENIC INJURIES DUE TO BLUNT ABDOMINAL TRAUMA

1) Department of Emergency and Critical Care Medicine, Tokai University School of Medicine, Isehara, Japan
2) Department of Surgery, Tokai University School of Medicine, Isehara, Japan

Sadaki Inokuchi1), Tomoo Tajima2), Masami Ikeda1), Isao Nakajima1), Akira Shotsu1), Toshio Mitomi2)

Surgical repair for complex splenic trauma is often controvertial, because the operative risk of splenic salvage may exceed the risk of overwhelming postsplenectomy infection (OPSI). To determine the operative risk of splenic salvage for such injuries, 19 cases of isolated but complex injuries among 73 cases of blunt splenic trauma were examined retrospectively. Shattered spleens were excluded from the study.
Splenic repair was accomplished successfully in all 10 attempted cases. Prior to the repair, vascular isolation and temporal occlusion of splenic artery was done to control the bleeding from injured spleen. In another 9 cases, splenectomy was immediately performed after laparotomy. Total amount of blood loss and operative morbidity in each group were not different, and no death occurred in both groups. Operative time was longer in group of splenic repair (112±20min) in comparison to splenectomy group (71±23min). Postoperative peripheral platelet count, serum lgM level, and finding of RBC scan showed adequate functional activity of the repaired spleen.
In conclusion, it is felt that surgical repair should be attempted for isolated but complex splenic injury, and that the spleen should be preferably repaired even with associated injuries, unless prolonged operative time does not increase operative risk to more than that of OPSI.

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