Splenic infarction surgery

Surgical therapy

• For an infarcted spleen with any of the above-mentioned complications, splenectomy is required.

• Because of the small but real risk of fatal overwhelming post splenectomy sepsis, splenic preservation is preferable whenever possible.

• In cases of torsion of a wandering spleen, splenopexy with splenic salvage is the procedure of choice in the well-perfused, non infarcted spleen.

• Complications such as bleeding or pseudocyst formation also may be amenable to splenic salvage using techniques of partial splenectomy.

• While a unilocular abscess can be managed successfully in select cases with percutaneous catheter drainage, some authors advocate splenectomy in all cases of splenic infarct and abscess, questioning the utility of preserving the residual partially functioning spleen. This may be accomplished using traditional open techniques or laparoscopic techniques.

• Perisplenic inflammation and dense adhesions can make splenectomy difficult. Another choice is to perform preoperative splenic artery embolization, which purposely infarcts the remaining spleen and minimizes blood loss that otherwise can be quite profuse in these difficult dissections.

Intraoperative ligation of the splenic artery at the superior margin of the pancreas in the lesser sac is another alternative to minimize blood loss if the spleen is enlarged.

Contraindications:

• Asymptomatic infarct without complication does not require surgical intervention.

• Overall, most splenic infarcts do not require surgical intervention.