Iatrogenic Splenic Injury

Kevin Cassar, Alasdair Munro

    Research output: Contribution to journalArticle

    60 Citations (Scopus)

    Abstract

    Background: Iatrogenic injury to the spleen is a recognised complication of abdominal surgery but the extent of the problem is often under-estimated. This may be due to failure to report splenic injury on the operation note or inaccurate recording of the indication for splenectomy. In this review article we have tried to estimate the incidence of iatrogenic splenic injury during abdominal surgery, the morbidity and mortality associated with splenic injury and the risk factors for injury to the spleen. We have also identified the common types and mechanisms of injury to the spleen and have made suggestions as to how splenic injury can be avoided and, when it occurs, how it should be managed. Methods: A Medline literature search was. performed to identify articles relating to "incidental splenectomy", "iatrogenic splenic injury", "iatrogenic splenectomy" and "splenectomy as a complication of common abdominal procedures". The relevant articles from the reference lists were also obtained. Results: Up to 40% of all splenectomies are performed for iatrogenic injury. The risk of splenic injury is highest during left hemicolectomy (1-8%), open anti-reflux procedures (3-20%), left nephrectomy (4-13%) and during exposure and reconstruction of the proximal abdominal aorta and its branches (21-60%). Splenic injury results in prolonged operating time, increased blood loss and longer hospital stay. It is also associated with a two to ten-fold increase in infection rate and up to a doubling of morbidity rates. Mortality is also reported to be higher in patients undergoing splenectomy for iatrogenic injury. The risk of injury to the spleen is higher in patients who have previously undergone abdominal surgery, in the elderly and in obese patients. A transperitoneal approach significantly increases the risk of splenic injury during,left nephrectomy compared with an extraperitoneal approach and the risk is even higher if the indication for surgery is malignancy. Excessive traction, injudicious use of retractors and direct trauma are the commonest mechanisms of injury. Conclusions: The incidence of iatrogenic splenic injury is underestimated because of poor documentation. Splenic injury during abdominal surgery can be reduced by achieving good exposure and adequate visualisation, avoiding undue traction and by early careful division of splenic ligaments and, adhesions. When the spleen is injured splenic preservation is desirable and often feasible, but this should not be at the expense of excessive blood loss.

    Original languageEnglish
    Pages (from-to)731-741
    Number of pages10
    JournalThe Surgeon
    Volume47
    Issue number6
    Publication statusPublished - Dec 2002

    Keywords

    • iatrogenic splenic injury
    • spleen
    • splenectomy
    • incidental splenectomy
    • transhiatal esophagectomy
    • Nissen fundoplication
    • surgical-treatment
    • donor nephrectomy
    • colorectal-cancer
    • changing concepts
    • mortality
    • autotransplantation
    • complications

    Cite this

    Cassar, K., & Munro, A. (2002). Iatrogenic Splenic Injury. The Surgeon, 47(6), 731-741.

    Iatrogenic Splenic Injury. / Cassar, Kevin; Munro, Alasdair.

    In: The Surgeon, Vol. 47, No. 6, 12.2002, p. 731-741.

    Research output: Contribution to journalArticle

    Cassar, K & Munro, A 2002, 'Iatrogenic Splenic Injury' The Surgeon, vol. 47, no. 6, pp. 731-741.
    Cassar K, Munro A. Iatrogenic Splenic Injury. The Surgeon. 2002 Dec;47(6):731-741.
    Cassar, Kevin ; Munro, Alasdair. / Iatrogenic Splenic Injury. In: The Surgeon. 2002 ; Vol. 47, No. 6. pp. 731-741.
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    AB - Background: Iatrogenic injury to the spleen is a recognised complication of abdominal surgery but the extent of the problem is often under-estimated. This may be due to failure to report splenic injury on the operation note or inaccurate recording of the indication for splenectomy. In this review article we have tried to estimate the incidence of iatrogenic splenic injury during abdominal surgery, the morbidity and mortality associated with splenic injury and the risk factors for injury to the spleen. We have also identified the common types and mechanisms of injury to the spleen and have made suggestions as to how splenic injury can be avoided and, when it occurs, how it should be managed. Methods: A Medline literature search was. performed to identify articles relating to "incidental splenectomy", "iatrogenic splenic injury", "iatrogenic splenectomy" and "splenectomy as a complication of common abdominal procedures". The relevant articles from the reference lists were also obtained. Results: Up to 40% of all splenectomies are performed for iatrogenic injury. The risk of splenic injury is highest during left hemicolectomy (1-8%), open anti-reflux procedures (3-20%), left nephrectomy (4-13%) and during exposure and reconstruction of the proximal abdominal aorta and its branches (21-60%). Splenic injury results in prolonged operating time, increased blood loss and longer hospital stay. It is also associated with a two to ten-fold increase in infection rate and up to a doubling of morbidity rates. Mortality is also reported to be higher in patients undergoing splenectomy for iatrogenic injury. The risk of injury to the spleen is higher in patients who have previously undergone abdominal surgery, in the elderly and in obese patients. A transperitoneal approach significantly increases the risk of splenic injury during,left nephrectomy compared with an extraperitoneal approach and the risk is even higher if the indication for surgery is malignancy. Excessive traction, injudicious use of retractors and direct trauma are the commonest mechanisms of injury. Conclusions: The incidence of iatrogenic splenic injury is underestimated because of poor documentation. Splenic injury during abdominal surgery can be reduced by achieving good exposure and adequate visualisation, avoiding undue traction and by early careful division of splenic ligaments and, adhesions. When the spleen is injured splenic preservation is desirable and often feasible, but this should not be at the expense of excessive blood loss.

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    KW - spleen

    KW - splenectomy

    KW - incidental splenectomy

    KW - transhiatal esophagectomy

    KW - Nissen fundoplication

    KW - surgical-treatment

    KW - donor nephrectomy

    KW - colorectal-cancer

    KW - changing concepts

    KW - mortality

    KW - autotransplantation

    KW - complications

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