The influence of splenectomy on infective morbidity after colonic and splenic injuries.
OBJECTIVE
To establish the incidence of early postoperative infections after civilian injuries to the spleen, colon, or both and assess the effect of splenectomy on outcome.


METHODS
Retrospective study of case notes.


METHODS
University hospital.


METHODS
403 Patients of whom 353 had splenic injuries, 91 with associated colonic injuries, together with 50 randomly selected patients with colonic injuries alone.


METHODS
Morbidity and mortality.


RESULTS
45 Patients had splenectomy and colonic injury (group 1), 46 had a colonic injury and the spleen conserved (group 2) 50 had colonic injury alone (group 3), 143 had splenectomy for injured spleen without colonic injury (group 4), and 119 had the spleen injured and conserved without colonic injury (group 5). Their mean age was 28 years. Overall mean Injury Severity Score (ISS) was 30.1, and Abdominal Trauma Index (ATI) 22.4. 68/403 died (17%), more than half within 48 hours. Early mortality was higher in both groups in which the spleen was removed but after stratification by ISS and ATI the differences were not significant. Late mortality (after 48 hours) associated with sepsis did not differ significantly among the groups, nor did the rate of infective complications. Mechanism and severity of injury had the most influence on morbidity and mortality.


CONCLUSIONS
Removal of an injured spleen does not have an adverse influence on the incidence of serious infective complications in the early postoperative period in patients with injuries to the spleen, the colon, or both.
Huizinga
W K
WK
Department of Surgery, Natal University, Medical School, Durban, South Africa.
Baker
L W
LW
D000328:Adult; D016009:Chi-Square Distribution; D003106:Colon / Q000293:injuries* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D009017:Morbidity; D012189:Retrospective Studies; D013154:Spleen / Q000293:injuries* / Q000601:surgery; D013156:Splenectomy / Q000401:mortality; D013530:Surgical Wound Infection / Q000209:etiology* / Q000401:mortality; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery*; D014950:Wounds, Penetrating / Q000401:mortality / Q000601:surgery*