Septic sequelae after splenectomy for trauma in adults

Abstract

Of 619 trauma patients who underwent splenectomy, 503 lived more than 10 days postoperatively. In this group systemic sepsis developed in 114 patients (22.7 percent). The most frequent septic focus was intraabdominal abscess (59 patients). The incidence of postoperative septic complications increased with the severity of trauma. Of the 41 patients who died after the 10th postoperative day, 36 died from sepsis. There were no septic complications or deaths in the 13 patients under age 15 years. Septic morbidity and mortality rates in splenectomized patients were significantly (p less than 0.01) greater than those in 2,368 consecutive trauma patients treated from 1978 to 1979. Long-term follow-up information was obtained in 242 patients. Follow-up encompassed 1,046 patient-years, with a mean patient follow-up interval of 4.4 years. Severe bacterial infections have occurred in six patients (2.5 percent). Thus far there have been no deaths from overwhelming sepsis. Interestingly, 11.5 percent of the patients complained of more severe viral infections after splenectomy. Our data support the concept of preserving the traumatized spleen whenever possible.