Complications of splenectomy

During the last three decades it has become clear that removal of the spleen, for any reason, is not a benign procedure. In both adults and children splenectomy places the patient at significantly higher risk of overwhelming infection, compared to the normal population. The risk of the post-splenectomy septic syndrome is lifelong and is not eliminated by the administration of polyvalent pneumococcal vaccine. Thus far, the reported rate of overwhelming sepsis in asplenic individuals has ranged from 2.5-13.5%. As more long-term follow-up data become available, it is likely that the true incidence will be 5-10%. In addition to this late complication, splenectomy increases the frequency of adverse events, including death, in the immediate postoperative period. Infections, particularly pulmonary and abdominal sepsis, constitute the majority of the complications. The mortality rate from postoperative sepsis is substantial. Atelectasis, pancreatitis/fistula, pulmonary embolism and bleeding at the operative site are also relatively common occurrences following splenic removal. These alarming statistics have spurred surgeons to change their attitudes concerning splenectomy for trauma, both accidental and iatrogenic. Nonoperative management of hemodynamically stable patients with isolated splenic injury and splenorrhaphy in patients requiring laparotomy are now firmly entrenched in the surgical armamentarium. Patients in whom splenectomy is necessary are given polyvalent pneumococcal vaccine and are instructed to seek early medical attention for febrile illnesses. Splenic autotransplantation and lifelong prophylactic antibiotic therapy have been used in some centers, but their clinical value remains to be proven.