[Evaluation of splenic function by dynamic gammagraphy, study of pitted erythrocytes and submembranous vacuoles in patients with slight and severe splenic trauma receiving conservative treatment or splenectomy].
OBJECTIVE
The splenic function of patients followed by the Department of General and Digestive Surgery in the Hospital Universitari Germans Trias i Pujol (HUGTiP) from 1985 to 2003 for different degrees of splenic trauma according to the classification of the American Association for the Surgery of Trauma (AAST) 1994 was quantified and related to the treatment received (non surgical, total splenectomy with or without splenosis and splenectomy plus autotransplantation) to detect splenic dysfunction predisposing the development of postsplenectomy sepsis (PSS).


METHODS
43 patients underwent an isotopic study with dynamic splenic gammagraphy and pitted erythrocytes (Normarsky optics) and submembranous vacuoles (transmission electron microscopy) were evaluated.


RESULTS
The non surgical group presented normal phagocytic and filtration function with the median speed of splenic enhancement being 3.46 Kcts/s2 (interval: 0.8-6.98). The percentage of pitted erythrocytes was 2% (0-8.8), the number of pits per erythrocyte was 0.03 (0-0.12) and the percentage of erythrocytes with 1, 2, 3 and 4 pits was 1.6%, 0.4%, 0% and 0%, respectively. The percentage of red cells with submembranous vacuoles was 2.55% (0-5.6), the number of vacuoles per red cell was 0.03 (0-0.06) and the percentage of red cells with 1, 2, 3 and 4 vacuoles was 2%, 0.2%, 0% and 0%, respectively. In the operated group, the splenic enhancement speed was 0.08 Kcts/s2 (0-1.75) (p < 0.0001). The percentage of pitted erythrocytes was 38% (0.2-64) (p < 0.0001), the number of pits per erythrocyte was 0.86 (0-1.8) (p < 0.0001) and the percentage of erythrocytes with 1,2,3 and 4 pits was 16.39%, 7.2%, 3.59% and 2.52%, respectively (p < 0.0001). The percentage of red cells with submembranous vacuoles was 11.2% (1.8-31.9) (p = 0.0006); the number of vacuoles per cell was 0.16 (p = 0.0022) and the percentage of red cells with 1, 2, 3 and 4 vacuoles was 6.51%, 1.73%, 0.4% and 0.2%, respectively (p = 0.0246, 0.0010, < 0.0001 and 0.0002, respectively).


CONCLUSIONS
Splenic function of patients with a history of splenic trauma receiving conservative treatment is normal, independently of the degree of the lesion, thereby reinforcing the use of this therapeutic approach to avoid the development of postsplenectomy sepsis. In the patients treated with splenectomy, with or without splenosis, splenic function was absent or very altered being partially conserved in cases treated with splenectomy plus autotransplantation.
Pacha-González
Miguel Angel
MA
Departamento de Cirugía, Hospital Universitari Germans Trias i Pujol, Facultad de Medicina, Universidad Autónoma de Barcelona, Badalona, Barcelona, España.
Oller-Sales
Benjamí
B
Feliu
Evarist
E
Millá
Fuensanta
F
Xandri
Marisol
M
Troya
José
J
Roca
Josep
J
Riba
Joaquim
J
Fraile
Manel
M
Martínez-Cáceres
Eva María
EM
Rodríguez
Nivardo
N
Martínez
María Jesús
MJ
Pujol-Borrell
Ricardo
R
Fernández-Llamazares
Jaume
J
D000328:Adult; D004913:Erythrocytes, Abnormal; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D011877:Radionuclide Imaging; D013154:Spleen / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D013156:Splenectomy; D014617:Vacuoles