Spleen

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Although the spleen is protected by the left lower ribs and is held in place by peritoneal ligamentous attachments, it is the most common solid organ injured in blunt trama. Its has a spongy structure, with little collagenous tissue, and the capsule is rather thin. Thus the spleen is easily injured, leading to considerable hemorrhage in a short time. The capsule may remain intact while the parenchyma is injured, although this occurs in only 2 per cent of cases. This leads to a subcapsular hematoma with absence of signs in the immediate post-traumatic period. Delayed rupture may occur weeks later, leading to hemorrhagic shock.

The spleen is the principal organ for clearing the circulation of non-opsonized bacteria. Post-traumatic splenectomy can be complicated years later by an overwhelming post-splenectomy infection (OPSI), with an annual risk of 0.5 per cent.

These considerations have led to the understanding that splenic salvage in trauma is important. Techniques for splenorrhaphy include absorbable mesh-wrap, partial splenectomy, or conservative treatment. Results of splenic autotransplantation are still not convincing.

If splenectomy is inevitable, postoperative pneumococcal vaccine should be administered. As the effectiveness of this vaccination is still uncertain, patients should be informed about the risk of OPSI. Further prevention of OPSI includes early evaluation by a physician in the case of fever above 38.5 °C and a generous use of prophylactic antibiotics.

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