Splenorrhaphy for blunt trauma with a functioning distal splenorenal shunt: rationale and report of a case

Splenorrhaphy was successfully performed following blunt abdominal trauma in a 42-year-old man with a functioning distal splenorenal shunt. The shunt had been created 16 months earlier for bleeding gastroesophageal varices (BGEV) secondary to alcoholic cirrhosis. Uniquely, this case brings into simultaneous focus the principles of selective shunting for BGEV and the technique and rationale of splenorrhaphy, while furthering the list of indications for the latter. Splenic preservation, including splenorrhaphy following trauma, is being increasingly advocated as the role of that organ in hematologic and immunologic homeostasis is further elucidated. Too, in that small segment of the population with portal hypertension, preservation of the spleen for use as a route of selective decompression for bleeding gastroesophageal varices has been emphasized. The following case illustrates splenic preservation toward accomplishment of both of these ends.