Purpose
Surgery is prioritized for a splenic injury when the patient is hemodynamically unstable or the injury is severe and there is an increased risk of bleeding. This study aimed to examine the outcomes of splenectomies where a surgical stapling device was used to reduce operation time and rapidly control bleeding.
Methods
This retrospective study included 53 patients who underwent a splenectomy for traumatic splenic injury at Chosun University Hospital between 2012 and 2017. Clinical outcomes including operation time (duration), blood transfusion amount (number of units), length of hospital stay, length of intensive care unit stay, and mortality rate were compared between patients who received conventional ligation [conventional group (CG)] and patients who received a splenectomy where a surgical stapling device was used [stapling group (SG)].
Results
The SG showed an average operation time of 17 minutes less than the CG, although the reduction was not statistically significant. No significant differences in estimated blood loss and blood transfusion amount were determined between the 2 groups, although the SG received 1 more unit of red blood cells for transfusion in the 48-hour post-operative period compared with the CG. One case of pancreatic fistula as a postoperative complication was reported in the SG.
Conclusion
The use of a surgical stapling device in a splenectomy may be considered for a hemodynamically unstable patient with splenic injury which caused severe anatomical damage.

A 19-year-old otherwise healthy male presented to the Emergency Department with left upper quadrant abdominal pain having felt a “pop” in his abdomen which was followed by nausea and lightheadedness. There was no evidence of trauma but 3 weeks earlier he began with symptoms of a sore throat and nasal congestion without cough. On subsequent investigation, given the patient’s acute abdominal pain, abnormal vitals and a non-diagnostic computed tomography scan, an emergent exploratory laparotomy was performed. There was 600 mL of blood evacuated from the abdomen. A 643-gram inflamed and ruptured spleen was identified and removed, and follow-up lab work was positive for heterophile antibody. This report describes spontaneous splenic rupture caused by infectious mononucleosis and compares characteristics of traumatic versus non-traumatic cases.

Citations

• Splenic rupture or infarction associated with Epstein-Barr virus infectious mononucleosis: a systematic literature review
  Johannes M. A. Toti, Beatrice Gatti, Isabella Hunjan, Lisa Kottanattu, Pietro B. Faré, Samuele Renzi, Mario G. Bianchetti, Gregorio P. Milani, Sebastiano A. G. Lava, Pietro Camozzi
  Swiss Medical Weekly.2023; 153(5): 40081.     CrossRef
• Esplenectomía laparoscópica mano asistida en ruptura esplénica atraumática secundaria a mononucleosis: reporte de un caso
  Lucía Sagüi-De la Fuente, Ana Fernanda Álvarez-Barragán, Guadalupe Javier Palacios-Saucedo, José Javier García-Salas, Guillermo Daniel Almaraz-Celis
  Revista Mexicana de Cirugía Endoscópica.2021; 22(2): 89.     CrossRef