INDICATIONS FOR SPLENECTOMY

Traumatic splenic rupture

• Splenic rupture is usually caused by blunt or penetrating trauma (see the first, second, and third images below); delayed rupture of the spleen and spontaneous splenic rupture occur rarely.

GRADE 4 SPLENIC INJURY

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CT scan of abdomen

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• Surgical management of splenic rupture is indicated for patients who have hemodynamic instability or shock on admission, those who have associated injuries necessitating operative intervention, and those in whom nonoperative management has failed

Blood dyscrasias

• Patients with various hematologic disorders may benefit from splenectomy. Splenomegaly is observed in conditions such as idiopathic (immune) thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), and hereditary spherocytosis. Of these, ITP is the most common indication for elective splenectomy. In hereditary spherocytosis, the RBCs have a tendency to be trapped and destroyed in the spleen. The main features of this disease include anemia, reticulocytosis, jaundice, and splenomegaly.

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• Other disorders for which splenectomy may be indicated include the following:
• Hodgkin disease - In patients who are refractory to medical therapy, splenectomy is indicated to decrease pain, fullness, and hypersplenism

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• Felty syndrome (rheumatoid arthritis, splenomegaly, and neutropenia) - Symptomatic splenomegaly and neutropenia can be corrected by splenectomy

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• Splenic abscess, cyst, sarcoidosis

CONTRAINDICATIONS

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• Contraindications to open splenectomy are few. For elective open splenectomy, the only absolute contraindications are uncorrectable coagulopathy and severe cardiovascular disease that prohibits the administration of general anesthesia.