Most Common Indication for Splenectomy

Trauma is the most common indication for splenectomy, particularly blunt trauma from motor vehicle accidents. 1, 2, 3

Indications for Splenectomy

Hemodynamic instability unresponsive to resuscitation with splenic injury of any grade 4
Failed non-operative management with ongoing bleeding or hemodynamic deterioration 4, 5
Total splenic avulsion or grade V injury with complete devascularization 4
Grade IV splenic trauma involving laceration of segmental or hilar vessels producing major devascularization (>25% of spleen), particularly in centers without angiography/angioembolization capabilities 4
Unipolar apical spleen laceration with active bleeding that cannot be controlled non-operatively 4

Hematologic disorders (15.6% of cases) including immune thrombocytopenic purpura, autoimmune hemolytic anemia, and congenital hemolytic anemias 3
Hematologic malignancies (15.4% of cases) such as lymphoma, leukemia 3
Hypersplenism/splenomegaly, particularly in portal hypertension 2
Iatrogenic splenic injury during another procedure (8.1% of cases) 3
Incidental splenectomy during adjacent organ resection (12.3% of cases) 3

NOM is the preferred approach for hemodynamically stable patients with splenic injuries of any grade 4, 5
NOM success rate ranges from 86-100% when combined with angiography/angioembolization (AG/AE) 5
Factors affecting NOM success include:
- Hemodynamic stability 5
- Grade of splenic injury 5
- Presence of vascular abnormalities on CT scan 5
- Availability of intensive monitoring 5

AG/AE should be considered in hemodynamically stable patients with:
- Moderate to severe injuries 5
- Vascular abnormalities on CT scan (contrast blush, pseudo-aneurysms, arterio-venous fistula) 5
- Signs of persistent hemorrhage 5
AG/AE has reduced the need for operative management, with a reported success rate of 73-100% 5

Indications for operative management include:
- Hemodynamic instability unresponsive to resuscitation 5
- Failed non-operative management 5
- Severe coexisting injuries requiring intervention 5
- Peritonitis or bowel evisceration 5
Splenectomy is the preferred treatment when NOM fails 5
Partial splenic preservation should be attempted when possible 5

NOM is successful in 95-100% of blunt pediatric trauma patients and is the gold standard for hemodynamically stable children 5
Splenectomy should be avoided in hemodynamically stable children with isolated splenic injury 5
Children with moderate-severe blunt splenic injuries should be considered for transfer to dedicated pediatric trauma centers 5

Infections remain the most dangerous complication of splenectomy 6
Increased risk of infections with encapsulated bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis) 6
Increased risk of venous thromboembolism 6
Post-splenectomy vaccination is essential to reduce the risk of overwhelming infections 6

The incidence of splenectomy has decreased significantly over the past decades 3
Traumatic splenectomy has decreased by 32.9% over a 5-year period in one study 3
This decrease reflects improved non-operative management strategies and recognition of the importance of splenic preservation 3

Delayed splenic rupture can occur days to weeks after initial injury, requiring vigilant monitoring 4
Patients with severe traumatic brain injury and high-grade splenic injuries may benefit from early splenectomy in centers without immediate AG/AE availability 4
Laparoscopic splenectomy is not recommended in acute trauma with active bleeding 4