Accidental splenic injury during surgical treatment of the colon and rectum.

Although operative injury to the spleen continues to account for a large number of splenectomies, the incidence of injury during operations upon the colon and rectum has not previously been reported. Of 993 consecutive colonic and rectal excisions, the spleen was injured in eight and splenectomy resulted in three. Two hundred and sixty patients had the splenic flexure of the colon mobilized. All splenic injuries occurred in this group (3.1 per cent) for an incidence of splenectomy during splenic flexure mobilization of 1.15 per cent. In all patients, splenic injury consisted of a capsular tear and was a result of traction on spleno-omental peritoneal bands in 50 per cent. The spleen was salvaged using topical hemostatic agents in 63 per cent of the injuries. A method of splenic flexure mobilization which improves visualization of splenic attachments and avoids traction injuries is discussed. The morbidity and mortality from traumatic splenectomy are also reviewed.