The spleen at risk after penetrating trauma.
In contrast to blunt splenic trauma where nonsurgical management is an option, splenorrhaphy is the current preferred approach for penetrating trauma. Splenectomy, however, may be required because of hemodynamic instability, the extent of the trauma, or when a pancreatic injury requires distal pancreatectomy. We evaluated our attempts at splenic preservation in 69 patients (1988-1992) in whom the spleen was at risk for removal. Fifty-seven patients had penetrating injury to the spleen and 12 patients had distal pancreatectomy. Splenic Trauma (n = 57): 6 patients (mean Abdominal Trauma Index 45) died within 24 hours of extensive injuries. All had splenectomy. Thirty-seven of the remaining 51 (72.5%) had successful splenorrhaphy, 85% with stab wounds (SWs) and 65.5% with gunshot wounds (GSWs). Splenic salvage was 100%, 100%, 92%, 37%, and 0%, respectively, for grades I-V injuries. Absorbable mesh splenorrhaphy improved splenic salvage in grade III and IV injuries from 67% and 0% in previous years (1983-1987) to 92% and 37% in recent years (1988-1992), p < 0.01. The use of the mesh did not increase septic complications, even in the presence of enteric perforation. Distal Pancreatectomy (n = 12): 1 died intraoperatively. The spleen was not injured in 6 and was preserved in all 6. The overall 54.5% splenic salvage rate was achieved without increasing morbidity or the number of transfusions.


CONCLUSIONS
(1) Splenorrhaphy should be possible in the great majority of stable patients after penetrating trauma. (2) Absorbable mesh is a valuable adjunct that may facilitate the repair of more severe grades of splenic trauma.(ABSTRACT TRUNCATED AT 250 WORDS)
Department of Surgery, New York Medical College, Bronx.
R R
RR
Ivatury
R J
RJ
Simon
J
J
Guignard
J
J
Kazigo
Y
Y
Gunduz
W M
WM
Stahl
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D010179:Pancreas / Q000293:injuries; D010180:Pancreatectomy; D011183:Postoperative Complications; D013154:Spleen / Q000293:injuries* / Q000601:surgery; D013156:Splenectomy; D014948:Wounds, Gunshot / Q000601:surgery; D014950:Wounds, Penetrating / Q000601:surgery*; D014951:Wounds, Stab / Q000601:surgery