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}

A 29-year-old man arrived at the emergency department following blunt abdominal trauma in a car accident. He presented with acute abdomen. A CT scan demonstrated a large hemoperitoneum associated with a traumatic rupture of the spleen with lesions in the superior polar segmental vessel (figure 1). The lesion was classified as Grade III, according to the standards of the OIS Committee. The patient underwent an urgent laparotomy. At laparotomy after aspiration of 2 L of blood, the spleen was mobilised with ligation of the gastrosplenic vessels and liberation of the spleno-pancreatic axis. The rupture of the upper pole was found, and the superior polar vessels were ligated, preserving the inferior polar branches. The splenic tissue was compressed digitally across normal parenchyma adjacent to the injury. Only the capsule and vascular cords of connective tissue remained between the surgeon's fingers. Here we applied the GIA-75 stapler and removed the traumatised upper pole. On the staple line we applied the FloSeal matrix haemostatic agent (Baxter Healthcare, Fremont, California, USA) with complete haemostasis. In order to avoid torsion of the splenic remnant, it was positioned and fixed into the left-upper quadrant using human fibrin glue (Tissucol; Baxter Healthcare, Deerfield, Illinois, USA). His postoperative course was uneventful, and the patient was discharged on the 10th postoperative day. An abdomen CT scan was repeated 30 days later (figure 2A-F).

In the past years, a ruptured spleen caused by blunt abdominal injury was usually treated by splenectomy. Splenectomised patients have an acquired immunodeficiency state and are at increased life-long risk of serious infections. Because these patients are usually otherwise healthy and often relatively young, alternatives for total splenectomy have been sought.³ In the 1980s, partial stapled resection gained prominence and was a commonly performed procedure for elective and trauma surgery.⁴ Resection with stapler makes organ conservation possible in many cases, which would previously have required total splenectomy.⁸ Supplemental haemostasis of the parenchyma can be successfully performed by the application of fibrin glue or collagen fleece. FloSeal matrix haemostatic agent (Baxter Healthcare) consists of a gelatin matrix and a thrombin component, which are mixed together before use. Cross-linked gelatin granules in the matrix swell approximately 20% on contact with blood or bodily fluids, slowing blood flow. The coagulation cascade is activated by the thrombin component to form a firm haemostatic plug. These two processes combine to effect haemostasis by tamponade.⁵ We found it a quick and effective adjunct to the prevention of further bleeding from the cut surface of spleen. Furthermore, we recommend to fix the splenic remnant into the left-upper quadrant to avoid torsion of splenic tissue.⁴ In particular, we employed human fibrin glue.