The complex splenectomy

Abstract

The management of iatrogenic splenic injury in the complex surgical patient involves important decision-making steps. Patients in the appropriate setting who are hemodynamically stable and exhibit no peritoneal signs may undergo a trial of non-operative management (NOM). This includes a period of observation, intensive monitoring, serial abdominal examinations, serial hematocrit measurements, repeat CT imaging with or without the use of angioembolization. Patients who fail NOM, i.e., become hemodynamically unstable, require transfusion of 2 more units of packed red blood cells, develop peritoneal signs, or fail angioembolization require laparotomy. In the convalescing complex surgical patient with physiological derangement, the operation of choice is to perform a splenectomy.