Splenectomy in trauma

Splenectomy in trauma

Splenectomy, the surgical removal of the spleen, is often performed in trauma cases where the spleen is severely injured. The spleen is a vital organ located in the upper left abdomen, responsible for filtering blood and aiding the immune system. Due to its location and rich blood supply, it is particularly vulnerable to blunt abdominal trauma, such as from car accidents, falls, or sports injuries. In such cases, the spleen can suffer lacerations or even rupture, leading to significant internal bleeding.

In trauma, the decision to perform a splenectomy depends on the severity of the splenic injury. Minor splenic injuries, such as small lacerations or hematomas, may be managed without surgery through observation, blood transfusions, or interventional radiology techniques like splenic artery embolization, which reduces blood flow to the spleen. However, when there is significant damage or uncontrolled bleeding, a splenectomy becomes necessary to save the patient’s life.

Surgical approaches to splenectomy in trauma can vary. In emergency situations, an open splenectomy is usually performed because it allows the surgeon quick access to the abdominal cavity to control hemorrhage and assess other potential injuries. For less severe or delayed cases, a laparoscopic approach, which is minimally invasive, may be considered. Regardless of the method, the goal of the surgery is to stop the internal bleeding and prevent shock or death from massive blood loss.

While the spleen is important, it is not essential for survival. People can live without their spleen, but its removal has consequences for the immune system. The spleen helps the body fight infections, especially those caused by encapsulated bacteria like *Streptococcus pneumoniae*, *Neisseria meningitidis*, and *Haemophilus influenzae*. Without a spleen, the body is more vulnerable to these infections, which can lead to serious conditions, such as overwhelming post-splenectomy infection (OPSI), a life-threatening complication.

To mitigate the risk of infections following a splenectomy, patients are vaccinated against encapsulated bacteria. Vaccines for *Streptococcus pneumoniae* (pneumococcal vaccine), *Neisseria meningitidis* (meningococcal vaccine), and *Haemophilus influenzae* type B (Hib vaccine) are administered either before or immediately after surgery. In some cases, long-term antibiotic prophylaxis may be prescribed to further reduce the risk of severe infections. Patient education on infection prevention is also critical.

In conclusion, splenectomy in trauma is often a life-saving procedure when the spleen is severely injured and cannot be repaired. Though the surgery effectively stops internal bleeding and stabilizes the patient, it also requires careful management of long-term immune health. Vaccinations and infection prevention strategies are essential for post-splenectomy patients to protect them from serious infections and ensure their well-being.