• L. D. Britt


A U.S. exchange student, who recently returned after spending 3 weeks backpacking in some of the remote areas of sub-Saharan Africa, presents to the emergency department complaining of a throbbing headache, fever, and left shoulder pain. The patient denies any recent trauma. She is diaphoretic and hemodynamically labile (blood pressure, 80mm Hg; pulse, 130) and has a distended abdomen, which is diffusely tender to palpation.


Splenic Artery Nonoperative Management Splenic Injury Splenic Rupture Acute Care Setting 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Aristotle. Parts of Animals, Book III. (Peck AL, trans.) Cambridge, MA: Harvard University Press, 1955.Google Scholar
  2. 2.
    Rosner F. The spleen in the Talmud and other early Jewish writings. Bull Hist Med 1972; 46(1):82–85.PubMedGoogle Scholar
  3. 3.
    Morgenstern L. A history of splenectomy. In Hiatt JR, Phillips EH, Morgenstern L, eds. Surgical Diseases of the Spleen. New York: Springer, 1999: 3.Google Scholar
  4. 4.
    Mayo WJ. Principles underlying surgery of the spleen, with a report on ten splenectomies. JAMA 1910; 54:14.Google Scholar
  5. 5.
    Morris DH, Bullock FD. The importance of the spleen in resistance to infection. Ann Surg 1919; 70:513.CrossRefPubMedGoogle Scholar
  6. 6.
    Eichner ER. Splenic function: normal, too much and too little. Am J Med 1979; 66(2):311–320.CrossRefPubMedGoogle Scholar
  7. 7.
    Downey EC, Shackford SR, Fridlund PH, Ninnemann JL. Long-term depressed immune functions in patients splenectomized for trauma. J Trauma 1987; 27(6):661–663.CrossRefPubMedGoogle Scholar
  8. 8.
    King H, Schumacher HB Jr. Splenic studies. I. Susceptibility to infection after splenectomy performed in infancy. Ann Surg 1952; 136(2):239–242.PubMedCrossRefGoogle Scholar
  9. 9.
    Lynch AM, Kapila R. Overwhelming postsplenectomy infection. Infect Dis Clin North Am 1996; 10(4):693–707.CrossRefPubMedGoogle Scholar
  10. 10.
    Sekikawa T, Shatney CH. Septic sequelae after splenectomy for trauma in adults. Am J Surg 1983; 145(5):667–673.CrossRefPubMedGoogle Scholar
  11. 11.
    Gopal V, Bisno AL. Fulminant pneumococcal infections in “normal” asplenic hosts. Arch Intern Med 1977; 137(11): 1526–1530.CrossRefPubMedGoogle Scholar
  12. 12.
    Diamond LK. Splenectomy in childhood and the hazard of overwhelming infection. Pediatrics 1969; 43(43):886–889.PubMedGoogle Scholar
  13. 13.
    Holdsworth RJ, Irving AD, Cuschieri A. Postsplenectomy sepsis and its mortality rate: actual versus perceived risks. Br J Surg 1991; 78(9):1031–1038.CrossRefPubMedGoogle Scholar
  14. 14.
    Robinette CD, Fraumeni JF Jr. Splenectomy and subsequent mortality in veterans of the 1939–45 war. Lancet 1977; 2(8029):127–129.PubMedGoogle Scholar
  15. 15.
    Singer DB: Post-splenectomy sepsis Perspect Pediatr Pathol 1973; 1:285–311.Google Scholar
  16. 16.
    Massad M, Murr M, Razzouk B, Nassourah Z, Sankari M, Najjar F. Spontaneous splenic rupture in an adult with mumps: a case report. Surgery 1988; 103(3):381–382.PubMedGoogle Scholar
  17. 17.
    Dixon JA, Miller F, McCloskey D, Siddoway J. Anatomy and techniques in segmental splenectomy. Surg Gynecol Obstet 1980; 150(4):516–520.PubMedGoogle Scholar
  18. 18.
    Barnhart MI, Lusher JM. Structural physiology of the human spleen. Am J Pediatr Hematol Oncol 1979; 1(4): 311–330.PubMedGoogle Scholar
  19. 19.
    Aster RH. Pooling of platelets in the spleen: role in the pathogenesis of “hypersplenic” thrombocytopenia. J Clin Invest 1966; 45(5):645–657.CrossRefPubMedGoogle Scholar
  20. 20.
    Stielm ER, Wokim M. The spleen in infection and immunity. In Hiatt JR, Phillips EH, Morgenstern L, eds. Surgical Disease of the Spleen. New York: Springer, 1997: 53.Google Scholar
  21. 21.
    Van Wyck DB, Witte MH, Witte CL, Thies AC Jr. Critical splenic mass for survival from experimental pneumococcemia. J Surg Res 1980; 28(1):14–17.CrossRefPubMedGoogle Scholar
  22. 22.
    Coon WW. Surgical aspects of splenic disease and lymphoma. Curr Probl Surg 1998; 35(7):543–646.CrossRefPubMedGoogle Scholar
  23. 23.
    Zingman BS, Viner BL. Splenic complications in malaria: case report and review. Clin Infect Dis 1993; 16(2):223–232.PubMedGoogle Scholar
  24. 24.
    Lally KP, Rosario V, Mahour GH, Woolley MM. Evolution in the management of splenic injury in children. Surg Gynecol Obstet 1990; 170(3):245–248.PubMedGoogle Scholar
  25. 25.
    Malangoni M, Levine AW, Droege EA, Aprahamian C, Condon RE. Management of injury to the spleen in adults Results of early operation and observation. Ann Surg 1984; 200(6):702–705.CrossRefPubMedGoogle Scholar
  26. 26.
    Wisner DH, Blaisdell FW. When to save the ruptured spleen. Surgery 1992; 111(2):121–122.PubMedGoogle Scholar
  27. 27.
    Uranus S, Pfeifer J. Nonoperative treatment of blunt splenic injury. World J Surg 2001; 25(11):1405–1407.CrossRefPubMedGoogle Scholar
  28. 28.
    Nix JA, Costanza M, Daley BJ, Powell MA, Enderson BL. Outcome of the current management of splenic injuries. J Trauma 2001; 50(5):835–842.CrossRefPubMedGoogle Scholar
  29. 29.
    Haller JA Jr, Papa P, Drugas G, Colombani P. Nonoperative management of solid organ injuries in children. Is it safe? Ann Surg 1994; 219(6):625–628.CrossRefPubMedGoogle Scholar
  30. 30.
    Schwartz MZ, Kangah R. Splenic injury in children after blunt trauma: blood transfusion requirements and length of hospitalization for laparotomy versus observation. J Pediatr Surg 1994; 29(5):596–598.CrossRefPubMedGoogle Scholar
  31. 31.
    Cocanour CS, Moore FA, Ware DN, Marvin RG, Duke JH. Age should not be a consideration for nonoperative management of blunt splenic injury. J Trauma 2000; 48(4):606–610.CrossRefPubMedGoogle Scholar
  32. 32.
    Peitzman AB, Heil B, Rivera L, et al. Blunt splenic injury in adults: multiinstitutional study of the Eastern Association for the Surgery of Trauma. J Trauma 2000; 49(2):177–187.CrossRefPubMedGoogle Scholar
  33. 33.
    Barone JE, Burns G, Svehlak SA, et al. Management of blunt splenic trauma in patients older than 55 years. Southern Connecticut Regional Trauma Quality Assurance Committee. J Trauma 1999; 46(1):87–90.CrossRefPubMedGoogle Scholar
  34. 34.
    Harbrecht BG, Peitzman AB, Rivera L, et al. Contribution of age and gender to outcome of blunt splenic injury in adults: multicenter center study of the Eastern Association for the Surgery of Trauma. J Trauma 2001; 51(5):881–895.CrossRefGoogle Scholar
  35. 35.
    Williams RA, Black JJ, Sinow RM, Wilson SE. Computed tomography-assisted management of splenic trauma. Am J Surg 1997; 174(3):276–279.CrossRefPubMedGoogle Scholar
  36. 36.
    Urban BA, Fishman EK. Helical CT of the spleen. Am J Roentgenol 1998; 170(4):997–1003.Google Scholar
  37. 37.
    Pachter HL, Hofstetter SR, Spencer FC. Evolving conception splenic surgery: splenorrhaphy versus splenectomy and postsplenectomy drainage: experience in 105 patients. Ann Surg 1981; 194(3):262–269.CrossRefPubMedGoogle Scholar
  38. 38.
    Britt LD, Berger J. Splenic repair and partial splenectomy. In Nyhus LM, Baker RJ, Fischer JE, eds. Mastery of Surgery, vol 2, 3rd ed. Boston: Little, Brown & Company, 1997: 1276–1281.Google Scholar
  39. 39.
    Schweizer W, Bohlen L, Dennison A, Blumgart LH. Prospective study in adults of splenic preservation after traumatic rupture. Br J Surg 1992; 79(12):1330–1333.CrossRefPubMedGoogle Scholar
  40. 40.
    Cogbill TH, Moore EE, Jurkovich GJ, et al. Nonoperative management of blunt splenic trauma: a multicenter experience. J Trauma 1989; 29(10):1312–1317.CrossRefPubMedGoogle Scholar
  41. 41.
    Feliciano DV, Spjut-Patrinely V, Burch JM, et al. Splenorrhaphy. The alternative. Ann Surg 1990; 211(5):569–580.CrossRefPubMedGoogle Scholar
  42. 42.
    Morgenstern L, Shapiro SJ. Techniques of splenic conservation. Ann Surg 1979; 114(4):449–454.Google Scholar
  43. 43.
    Dunham CM, Cornwell EE 3rd, Militello P. The role of Argon Beam Coagulation in splenic salvage. Surg Gynecol Obstet 1991; 173(3):179–182.PubMedGoogle Scholar
  44. 44.
    Sclafani SJ, Shaftan GW, Scalea TM, et al. Nonoperative salvage of computed tomography-diagnosed splenic injuries: utilization of angiography for triage and embolization for hemostasis. J Trauma 1995; 39(5):818–825.CrossRefPubMedGoogle Scholar
  45. 45.
    Moz MF, Spigos DG, Pollak R, et al. Partial splenic embolization, an alternative to splenectomy. Results of a prospective, randomized study. Surgery 1984; 96:694–702.Google Scholar
  46. 46.
    Haan JM, Biffl W, Knudson MM, et al: Improved success in nonoperative management of blunt splenic injuries: embolization of splenic artery pseudoaneurysms. J Trauma 1998; 44:1008–1015.CrossRefGoogle Scholar
  47. 47.
    Shweiki E, Klena J, Wood GC, Indeck M. Assessing the true risk of abdominal solid organ injury in hospitalized rib fracture patients. J Trauma 2001; 50(4):684–688.CrossRefPubMedGoogle Scholar
  48. 48.
    Rozycki GS, Ochsner MG, Jaffin JH, Champion HR. Prospective evaluation of surgeons’ use of ultrasound in the evaluation of trauma patients. J Trauma 1993; 34(4):516–526.CrossRefPubMedGoogle Scholar
  49. 49.
    Omert LA, Salyer D, Dunham CM, Porter J, Silva A, Protetch J. Implications of the “contrast blush” finding on computed tomographic scan of the spleen in trauma. J Trauma 2001; 51(2):272–277.CrossRefPubMedGoogle Scholar
  50. 50.
    Lange DA, Zaret P, Merlotti GJ, Roin AP, Sheaff C, Barrett JA. The use of adsorbable mesh in splenic trauma. J Trauma 1998; 28(3):269–275.CrossRefGoogle Scholar
  51. 51.
    Rogers FB, Baumgartner NE, Robin AP, Barrett JA. Absorbable mesh splenorrhaphy for severe splenic injuries: functional studies in an animal model and an additional patient series. J Trauma 1991; 31(2):200–204.PubMedGoogle Scholar
  52. 52.
    Moore GE, Stevens RE, Moore EE, Aragon GE. Failure of splenic implants to protect against fatal postsplenectomy infection. Am J Surg 1983; 146(3):413–414.CrossRefPubMedGoogle Scholar
  53. 53.
    Miller JR, Sirenek KR. Overwhelming postsplenectomy infection. J Surg Infect 1997; 3:1, 4–5.Google Scholar
  54. 54.
    Luna GK, Dellinger EP. Nonoperative observation therapy for splenic injuries: a safe therapeutic option? Am J Surg 1987; 153(5):462–468.CrossRefPubMedGoogle Scholar
  55. 55.
    Green JB, Shackford SR, Sise MJ, Fridlund P. Late septic complications in adults following splenectomy for trauma: a prospective analysis in 144 patients. J Trauma 1986; 26(11):999–1004.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • L. D. Britt
    • 1
  1. 1.Department of SurgeryEastern Virginia Medical SchoolNorfolkUSA

Personalised recommendations