Abstract

Splenectomy had been unchallenged as the treatment of the splenic injury until 1919, when Morris and Bullock reported that asplenic patients would show an increased susceptibility to infection. Since following report of fatal postsplenectomy sepsis by King and Shmacher in 1952, splenectomy for the traumatized spleen has come under considerable criticism and reconsideration of the splenic injuries began to occur. Subsequently, postsplenectomy sepsis has been reported in all age group by many others. With expanding knowledge 01 immunologic and physiologic function recognition 01 the risk of OPSI(overwhelming postsplenctomy infection) has led surgeon to attempt splenic salvage procedures. Successful results with repair of traumatized spleen has been reported such as simple suture, partial splenectomy and splenorrhaphy using pedicle of omentum or hemostatic adhesives. Now, we have attempted 23 cases of splenorrhaphy using omentum meat ball, which previously had been unreported and successful results were obtained. 1. Among 23 patients undergoing successful splenorrhaphy, mean age was 27 year old. The youngest patient was II 4 year old and the eldest was 74 year of age. The 21 of 23 patients were male. 2. 20 of the injuries (87 96) were due to blunt trauma. while 3 (13 %) were iatrogenic. of the 20 traumatic injuries, 14(70%) resulted from motor vehicle accident and 4(20%) from falling down. 3. 10 patients with shock and hemopentoneum were immediately operated. In equivocal physical findings, diagnostic peritoneal lavage (8 patients) and paracentesis (2 patients) were performed 4. 15 of 23 injuries were parenchymal lacerations, which showed upper pole (7) lower pole (6) and longitudinal injury (2). 5 injuries were crack to hilus, not dividing vessels and 3 injuries of iatrogenic injury were capsular avulsion. 5. 18 had associated injuries, of these 18, 10 were rib and pelvic bone fracture and 4 were intraabdominal injuries including liver (3), renal contusion (1). 6. Splenorrhaphy was performed in 21 of the 23 patients with horizontal mattress suture using omentum meat ball. Only 2 of 23 patients, required partial splenectomy and also obtained secure hemostasis with omentum.