Splenic function after splenic rupture treated with an absorbable mesh

Overwhelming postsplenectomy sepsis remains a problem despite the introduction of a vaccine and antimicrobial prophylaxis. Removal of the spleen increases the risk of death from overwhelming sepsis to approximately 50 times that in healthy persons. The morbidity and mortality due to infection increase with the extent of associated injuries. Between 1987 and 1991, 24 patients were admitted at the Katholieke Universiteit Leuven for a splenic injury and treated with an absorbable vicryl mesh (woven polyglycolic acid mesh; Polyglactine 910). The injuries to the spleen were classified according to Barrett. Three patients died of severe craniocerebral trauma. A splenectomy was performed in one polytraumatized patient because of rebleeding. The spleen was evaluated in 20 patients after a mean of 20 weeks using 99mTc-denaturated erythrocyte scintigraphy together with tomographies. A type IV injury is a contraindication. All abnormalities on scintigraphy are mainly seen in type III lesions and less in type II and type I lesions. In type IV injury splenectomy and autotransplantation are indicated. Except for type IV lesions, we conclude that a ruptured spleen can be safely treated with a vicryl mesh without great loss of function.