Abstract
Trauma is a public health problem and the most common cause of death in people under the age of 45. In blunt abdominal trauma, the spleen is the most commonly injured organ. Splenectomy remains the most common treatment, especially in high-grade lesions, despite increased nonoperative treatment. Removal of the spleen leads to increased susceptibility to infections due to its role in the immune function. Postsplenectomy sepsis is an important complication and presents a high mortality rate. Patients undergoing splenectomy should be immunized for encapsulated germs, as these are the agents most commonly associated with such infections. Splenic autotransplantation is a simple procedure, which can be an alternative to reduce infection rates consequent to total splenectomy, and reduce costs related to hospitalizations. This review aims to provide evidence-based information on splenic autotransplantation and its impact on the prognosis of patients undergoing total splenectomy. We searched the Cochrane Library, Medline/PubMed, SciELO and Embase, from January 2017 to January 2018 and selected articles in English and Portuguese, dated from 1919 to 2017. We found that the adjusted risk of death in splenectomized patients is greater than that of the general population, and when total splenectomy is performed, splenic autotransplantation is the only method capable of preserving splenic function, avoiding infections, especially postsplenectomy sepsis. Health professionals should be familiar with the consequences of the method chosen to manage the patient suffering from splenic trauma.
Highlights
The spleen is a lymphoid organ with three functional compartments[1]
It is the solid organ most frequently injured in blunt abdominal traumas[2], mainly due to its location and its rich vascularization
The purpose of this review is to provide evidencebased information regarding spleen autotransplantation as an alternative to complications of total splenectomy
Summary
The spleen is a lymphoid organ with three functional compartments[1]. Blunt splenic trauma accounts for 25% of solid organ damage and has mortality rates between 7% and 18%3. Complications of splenectomy have been known for years This was the only treatment in these cases. Even knowing the important functions of this organ, the negative consequences of its removal and the techniques that can preserve it, total splenectomy is still routinely performed, mainly due to patient’s severity or surgeon’s inexperience in managing the patient conservatively. Studies that propose criteria for indication for nonoperative treatment of splenic lesions of high grade[11] aim mainly to maintain spleen functions[10]. The purpose of this review is to provide evidencebased information regarding spleen autotransplantation as an alternative to complications of total splenectomy
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