Fatal overwhelming postsplenectomy infection.

A total of 776 patients underwent splenectomy at the Massachusetts General Hospital between 1962 and 1972. Follow-up information was obtained on 637 patients (82 percent), including 584 adults and 53 children. There was a total of 4,837 person-years of follow-up with a mean observation interval of 8.4 years. Four cases of fatal overwhelming postsplenectomy infection were identified. In our pediatric population, the incidence of fatal overwhelming postsplenectomy infection was 3.77 percent, which was significantly higher than the incidence of 0.34 percent in our asplenic adults. Overwhelming postsplenectomy infection is a unique clinical entity distinguishable from other infections. It may occur during the lifetime of any asplenic patient and especially in those patients who have had a splenectomy in childhood. In asplenic adults, the incidence is low. The aggressive approach to splenic preservation in the adult should be tempered by these results.