One Hundred Consecutive Splenectomies for Trauma: Is Histologic Evaluation Really Necessary?

Abstract

Splenectomy remains the most commonly performed abdominal operation for trauma. Although the vast majority of these patients (pts) are young and healthy, histologic evaluation is still routinely performed. We propose that routine histologic sampling of an injured yet otherwise grossly normal spleen is unnecessary. A retrospective review of 100 consecutive pathologic specimens of pts undergoing splenectomy for trauma at a Level I trauma center was performed during a 25-month period. Data are reported as mean +/- SD. Average age was 34.4 +/- 15.1 years. There were 78 men and 22 women. Average injury severity score was 28.3 +/- 12.9. The most common mechanisms of injury were motor vehicle collisions (56%) and motorcycle collisions (15%). Average length of stay was 17.4 +/- 19 days. Microscopic pathologic findings returned as benign with no evidence for neoplasia in 99 of 100 specimens. Mean specimen weight was 184.6 +/- 188.7 g. Only one spleen, which appeared grossly abnormal and weighed 1,800 g, had abnormal histology demonstrating extramedullary hematopoiesis. This pt died before further workup. Our review suggests that the routine microscopic evaluation of spleens removed after traumatic injury, as is currently the standard of care at our institution, is unnecessary. Such examination should only be performed in cases of marked splenomegaly or in spleens that appear grossly abnormal.

Traumatic Rupture of Massively Enlarged Spleen in Patient with Malignant Lymphoma and Thrombocytopenia - A Case Report

“…Fakhre et al, examining a total of 100 lacerated spleen after post-traumatic splenectomy, found only one case of 249 Traumatic rupture of massively enlarged spleen in patient with malignant lymphoma and thrombocytopenia histological features of extra-medullar haematopoesis in enlarged, weighted 1.8 kg spleen. Authors suggest that routinely histological examination of a normally looking spleen is not necessary and only cost consuming (9). Authors of this article share this opinion.…”

Clinicopathological features of splenectomy specimens: Experience of 16 years

“…Fakhre ve ark. 'nın (15) 100 splenektomiyi retrospektif olarak inceledikleri çalışmalarında ise yalnızca bir olguda patoloji saptamışlardır. Ayrıca, bu splenektomi materyalinin diğer splenektomilerden, makroskopik olarak belirgin derecede daha büyük olduğunu bildirmişler-dir.…”

Trauma Laparotomy: Evaluating the Necessity of Histological Examination

“…Fakhre et al evaluated 100 spleen pathology reports after trauma and noted a 100 per cent probability that a specimen will have corresponding benign pathology if it appears grossly normal. 1 Kraus et al concluded the expected rate of unanticipated pathology within a spleen removed incidentally or for therapy is approximately 1 per cent. 2 These studies strengthen our assertion that it is unlikely a specimen removed during trauma laparotomy will have abnormal pathology if it appears grossly normal.…”

“…Fakhre et al reviewed pathology reports for 100 consecutive spleens removed after trauma. 1 Ninety-nine of the 100 specimens had benign microscopic evaluations. One spleen was grossly abnormal, weighing 10 times the average.…”