The spleen is one of the intraabdominal organs most frequently damaged in cases of blunt abdominal trauma. The severity of signs and symptoms or the lack of experience of the surgeon often leads to total splenectomy.1
The spleen has important roles in organ defence, due to its filtering mechanism, phagocytosis and synthesis of complements factors and immunoglobulins.2
Recognition of a life-long risk of serious infections after splenectomy, known as overwhelming postsplenectomy infections, led to radical changes in the management of splenic trauma, encouraging splenic salvage techniques, including applications of haemostatic agents, splenorrhaphy and partial splenic resection.2 3
According to the literature, when at least 25% of healthy spleen parenchyma is preserved, all haematological immunological functions of this organ are kept.4 5
Splenic trauma is graded according to the standards of the Organ Injury Scaling (OIS) Committee published in 19896
: Grade 0 (subcapsular hematoma), Grade I (capsular tear), Grade II (superficial ruptures of the parenchyma without involvement of the ilus), Grade III (deep ruptures of the parenchyma, partly involving the hilus and segmental arteries; massive fragmentation of one pole) and Grade IV (massive fragmentation of the whole organ and/or total hilar tear).
The splenic vasculature is segmantal and highly variable. The splenic artery supplies the spleen and substantial portions of the stomach and pancreas. The splenic artery courses superior and anterior to the splenic vein, along the superior edge of the pancreas. Near the splenic hilum, the artery usually divides into superior and inferior terminal branches, and each branch further divides into four to six segmental intrasplenic branches. The superior terminal branches are usually longer than the inferior terminal branches and provide the major splenic arterial supply. A superior polar artery usually arises from the distal splenic artery near the hilum, but it may originate from the superior terminal artery. The inferior polar artery usually gives rise to the left gastroepiploic artery.7
The surgical anatomy of splenic vascularisation must be considered, as it can facilitate surgeons to perform partial resections.
In this report we describe the case of a young man presenting with splenic rupture for blunt abdominal trauma who underwent partial splenectomy.