Relation Between Splenectomy and Subsequent Infection: A Clinical Study

Abstract

A careful follow-up has been made of 142 patients on whom splenectomy was performed in childhood, and the figures for the incidence of infections have been statistically analysed. The incidence of septicemia and meningitis in infants after splenectomy was much higher than occurs in a normal infant population. A significant relation was found between the incidence of serious post-splenectomy infections and the age of the patient at operation. The greater susceptibility of infants was particularly striking when the analysis was confined to fatal and life-threatening infections such as septicemia and meningitis. In children over 1 year of age the risk of serious infections following splenectomy is still appreciable, except perhaps in the case of traumatic rupture of the spleen. Certain underlying diseases, including thalassemia and portal hypertension, themselves carry an increased risk of serious infection. Of all serious infections recorded following splectomy, 80% occurred within two years of operation. Post-splenectomy infections tend to follow a characteristic pattern. The course is fulminating, the mortality high, the infecting organism is predominantly pneumococcal and there is a tendency to recurrent attacks. In the few cases recorded of uncomplicated congenital absence of the spleen, infections strikingly similar to those following surgical removal of the spleen were the commonest findings noted at autopsy.