What is the role of splenectomy in the treatment of splenic infarct?

Updated: Jul 27, 2020
  • Author: Manish Parikh, MD; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

For an infarcted spleen with any of the above-mentioned complications, splenectomy is required. Because of the (admittedly small) risk of fatal OPSS, 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, noninfarcted spleen. Techniques include suturing the spleen to the surrounding structures, wrapping the organ in omentum or mesh prior to suture fixation, or placing it in a surgically created retroperitoneal pouch. This has been reported laparoscopically. [24]

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

Whereas 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 by using traditional open techniques or with laparoscopic techniques.

Perisplenic inflammation and dense adhesions can make splenectomy difficult. Another choice is to perform preoperative splenic artery embolization; this purposely infarcts the remaining spleen and minimizes blood loss, which 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.


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