Treatment of blunt injury of the spleen: is there a place for mesh wrapping?

OBJECTIVE

To describe our experience of treatment of blunt injury to the spleen and to assess the contribution of observation and mesh wrapping to outcome.

DESIGN

Retrospective study.

SETTING

Teaching hospital, Norway.

SUBJECTS

50 consecutive patients with blunt injuries to the spleen treated between 1987 and 1992.

INTERVENTIONS

36 of the 50 were operated on (15 of whom had other injuries as well). 19 Underwent splenectomy and the others had various conservation measures including 8 who had absorbable mesh wrapping applied.

RESULTS

14 Patients were successfully treated by observation alone (mean 8 days, range 4-14). 24 were operated on within 3 hours, and 12 after a period of observation, by a total of 18 surgeons (9 of whom dealt with only one such injury each). Half the eight patients who had absorbable mesh applied developed complications (rebleeding and pleural effusion, n = 2 each). Two patients died: one was a baby with an associated severe head injury and one had cirrhosis of the liver and had initially refused treatment but was admitted in a critical condition and died of coagulopathy after splenectomy.

CONCLUSION

Conservation with absorbable mesh wrapping should be attempted more often, but experience is necessary to do it properly. Given a protocol with explicit criteria for operation, we suggest that haemodynamically stable patients who require little or no blood transfusion should be observed carefully in the first instance.