Surgery & Perioperative/General / haematological surgery

Splenectomy

also: spleen removal · post-splenectomy sepsis · OPSI

Overview

Removal of the spleen — for trauma, haematological disease or hypersplenism. The lifelong infection prophylaxis afterwards is the high-yield point.

Mechanism

Surgical removal of the spleen. The spleen clears encapsulated organisms, so asplenic patients face lifelong risk of overwhelming post-splenectomy infection (OPSI) — hence vaccination + antibiotic prophylaxis.

Indications

Splenic trauma/rupture (if unstable / failed conservative)
Haematological: ITP, hereditary spherocytosis, hypersplenism
Some malignancies

The agents

Vaccination (pre-op if elective)prophylaxis

≥2 weeks before elective op

Pneumococcal, Hib, meningococcal ACWY+B, annual influenza — against encapsulated organisms.

Lifelong penicillin V prophylaxisprophylaxis

(erythromycin if allergic); carry a card; prompt antibiotics for any febrile illness.

Adverse effects

Overwhelming post-splenectomy infection (OPSI)serious

Fulminant sepsis from encapsulated organisms (pneumococcus) — the reason for vaccines + prophylaxis.

Thrombocytosis → VTE riskcommon

Subphrenic abscess, pancreatic tail injurycommon

Cautions & contraindications

Omitting vaccination / antibiotic prophylaxis after splenectomyall

OPSI risk — lifelong prophylaxis is mandatory.

Choosing it

Splenic rupture after blunt abdominal trauma with haemodynamic instability; or planned for ITP / hereditary spherocytosis — followed by a need for vaccines + lifelong penicillin.

Source: BNF — Asplenia prophylaxis · Green Book — Asplenia