THE INFLUENCE OF SPLENECTOMY ON INFECTIVE MORBIDITY AFTER COLONIC ANDSPLENIC INJURIES

Objective: To establish the incidence of early postoperative infection s after civilian injuries to the spleen, colon, or both and assess the effect of splenectomy on outcome. Design: Retrospective study of case notes. Setting: University hospital. Subjects: 403 Patients of whom 3 53 had splenic injuries, 91 with associated colonic injuries, together with 50 randomly selected patients with colonic injuries alone. Main outcome measures: Morbidity and mortality. Results: 45 Patients had sp lenectomy and colonic injury (group 1), 46 had a colonic injury and th e spleen conserved (group 2), 50 had colonic injury alone (group 3), 1 43 had splenectomy for injured spleen without colonic injury (group 4) , and 119 had the spleen injured and conserved without colonic injury (group 5). Their mean age was 28 years. Overall mean Injury Severity S core (ISS) was 30.1, and Abdominal Trauma Index (ATI) 22.4. 68/403 die d (17%), more than half within 48 hours. Early mortality was higher in both groups in which the spleen was removed but after stratification by ISS and ATI the differences were not significant. Late mortality (a fter 48 hours) associated with sepsis did not differ significantly amo ng the groups, nor did the rate of infective complications. Mechanism and severity of injury had the most influence on morbidity and mortali ty. Conclusion: Removal of an injured spleen does not have an adverse influence on the incidence of serious infective complications in the e arly postoperative period in patients with injuries to the spleen, the colon, or both.