SPL.E.N'IC I .NJURI .ES, CHEOICE OF .MA.N'AG.EMEN'T

Abstract

The spleen is the commonest intra abdominal organ injured in blunt abdominal trauma, and is a frequently injured organ in penetrating trauma. Untill recently, the routine management of splenic trauma was total splenectomy. The attitude of surgeons twards the management of splenic trauma has changed gradually over the last two decades by nearly 180 degree to a new policy of splenic conservation. This attitude was stimulated by the report made by king and shumacker in 1952 on the syndrome of overwhelming postsplenectomy Infection (OPSl), a severe septicaemia caused mostly by encapsulated bacteria (S. pneumeniae in 50% ( of cases) which may progress from onset to death within 24 hours. The syndrome is caused by loss of the immune function of the spleen, which is the principal organ for removal of nonopsonized antigens from the circulation. It is now apparent that the incidence of OPSt after trauma varies from 0.25 to 1%, being highest in children under 5 years of age,

and the mortality is reported to be 50 to 80%.

Studies of the splenic vasculature have demonstrated

• that the spleen is divided into varying number of segments, each with independent arterial supply and venous draina