Injury of the Spleen in Left-sided Transperi-toneal Nephrectomy and Adrenalectomy

Overview

The authors recorded from a total of 169 left-sided transperitoneal nephrectomies and sixadrenalectomies on account of tumourous changes, injuries of he spleen in 16 (9.14%) patients.Excessive traction and injury by a retractor were the most frequent causes of lineal injuries.The injury was treated in 12 patients by suture of the spleen. One patient with a subcapsularhaematoma did not need treatment. In three patients (1.7% in the whole group) were subjectedto splenectomy. Marked peroperative losses requiring transfusion were recorded in two pati-ents, similarly as in one patient with secondary haemorrhage during the postoperative period.Another postoperative complication occurred in a 77-year-old patient after splenectomy withpurulent secretion from the subphrenium and exacerbation of a preexisting proctocolitis whichwas complicated by transient renal failure and sudden death from susp. embolization. Preven-tion of injury involves systematic release of the spleen from its ligamentous apparatus andcareful surgical technique. The authors’ experience confirms that in the majority of patientsthe injury can be treated without the need of splenectomy.

Key words:
carcinoma of the kidney - transperitoneal nephrectomy and adrenalectomy - lienalinjury - incidental splenectomy