Spleen rupture is very serious.
The spleen is a solid organ with rich blood supply and fragile texture. It is fixed to the rear of the left upper abdomen by ligaments connected to its capsule. Although it is protected by the lower chest wall, abdominal wall and diaphragm, it is vulnerable to trauma and violence. It can easily rupture and cause internal bleeding.
After splenectomy, the integrity of human immune system function is destroyed, and the resistance to germs will inevitably decrease, making serious infections prone to occur. In the past, total splenectomy was considered the preferred treatment for splenic rupture, and many textbooks also advocated indications for total splenectomy regardless of the degree of splenic laceration. With the increasing reports of fulminant postsplenectomy infection (OPSI), mainly in children, this traditional concept has been challenged. Furthermore, partial splenectomy can be performed safely based on the anatomy of the spleen and existing hemostatic measures. Although the current principle of treatment of splenic rupture is still surgery, different surgical methods should be used as much as possible according to the degree of injury and the conditions at the time to preserve the spleen in whole or in part. The following surgical methods can be selected according to the specific conditions of the injury:
(1) Splenoplasty
It is suitable for splenic capsular laceration or linear splenic parenchymal laceration. For minor injuries, adhesive can be used to stop bleeding. If the effect is not satisfactory, repair surgery can be used. The key steps of the operation are to fully free the spleen so that it can be lifted out of the incision, use non-injurious vascular forceps or fingers to control the blood flow of the splenic pedicle, and suture active bleeding points with 1-0 catgut or 3-0 silk sutures. Then suture to repair the tear. If the needle hole bleeds after repair, hot saline gauze can be used to compress it or a hemostatic agent can be applied until the bleeding stops completely.
(2) Partial splenectomy
It is suitable for patients whose spleen tissue is difficult to stop bleeding or damaged by simple repair and has lost its vitality. After partial splenectomy, more than half of the spleen parenchyma can be preserved. . The operation should be performed with the spleen fully freed and the splenic pedicle under control. All the splenic tissue that has lost vitality should be removed, and each bleeding point should be ligated or sutured. If any bleeding occurs on the cut surface, apply a hemostatic agent and compress it with hot saline gauze until it completely stops. Cover with pedicled omentum.
(3) Total splenectomy
It is suitable for patients whose spleen is severely fragmented or whose splenic pedicle is broken and is not suitable for repair or partial splenectomy.
Proper preoperative preparation is of great significance in rescuing the wounded with shock. Transfusion of appropriate amounts of blood or fluid can improve the casualty's tolerance of anesthesia and surgery. If blood pressure and pulse still do not improve after rapid transfusion of 600 to 800 ml of blood, it indicates that there is still active bleeding, and emergency laparotomy is required to control the splenic pedicle while rapid blood transfusion under pressure. After controlling active bleeding, blood pressure and pulse can quickly improve, creating conditions for further surgical treatment. When the blood source is difficult, the blood accumulated in the abdominal cavity can be collected, and it is easy to re-transfuse the blood after filtration.