[Clinical aspects, pathophysiology, therapy and expert evaluation of splenectomy]

Abstract

Splenectomy increases on principle and for life the risk to die of a foudroyant postsplenectomy infection, the so called OPSI-syndrome. The main factors determining the frequency of the OPSI-syndrome are the age at time of operation and the indication for splenectomy. Postsplenectomy infection is mostly caused by pneumococci. In general the important pathophysiological factors are a lack of filtration capacity, a decreased opsonisation activity and a deficiency of early immunoglobulin production. The increased risk of children is probably caused by a physiologically reduced immune response and a cumulation of primary infections. In the foudroyant course of postsplenectomy infection therapy is mostly taken not in time, and mortality ranges between 50 and 80%. For this reason it is necessary to stress prophylaxis as: antibiotics, vaccination, autotransplantation and preserving surgery. The effectivity and application of these prophylactic measurements are clearly limited. Therefore it is very important to inform all patients and their parents about the low, but lifelong risk of infection following splenectomy in order to begin the antibiotic therapy as soon as possible even in cases of banal infections. In expert opinion about the loss of spleen the real situation of the splenectomized individual has to be regarded in making very precise analysis of the course of disease. This has to be done in considering the branch of insurance ordering the opinion (legal accident insurance, legal pensions insurance, social compensation law, private accident or life insurance). If infections or other illness often appear after splenectomy, these have to recognized as resulting impairment, provided that other causes have been excluded. In uncomplicated course it is not justified to suppose disability only by immanent risk.