Treatment of blunt injury of the spleen: is there a place for mesh wrapping?
OBJECTIVE: To describe our experience of treatment of blunt injury to the spleen and to assess the contribution of observation and mesh wrapping to outcome. DESIGN: Retrospective study. SETTING: Teaching hospital, Norway. SUBJECTS: 50 consecutive patients with blunt injuries to the spleen treated between 1987 and 1992. INTERVENTIONS: 36 of the 50 were operated on (15 of whom had other injuries as well). 19 Underwent splenectomy and the others had various conservation measures including 8 who had absorbable mesh wrapping applied. RESULTS: 14 Patients were successfully treated by observation alone (mean 8 days, range 4-14). 24 were operated on within 3 hours, and 12 after a period of observation, by a total of 18 surgeons (9 of whom dealt with only one such injury each). Half the eight patients who had absorbable mesh applied developed complications (rebleeding and pleural effusion, n = 2 each). Two patients died: one was a baby with an associated severe head injury and one had cirrhosis of the liver and had initially refused treatment but was admitted in a critical condition and died of coagulopathy after splenectomy. CONCLUSION: Conservation with absorbable mesh wrapping should be attempted more often, but experience is necessary to do it properly. Given a protocol with explicit criteria for operation, we suggest that haemodynamically stable patients who require little or no blood transfusion should be observed carefully in the first instance.