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September 1963

"Spontaneous Spontaneous Rupture" of the Spleen: One MechanismRoutine Splenectomy Challenged

Author Affiliations

Department of Surgery, University of Mississippi Medical Center.

Arch Surg. 1963;87(3):468-470. doi:10.1001/archsurg.1963.01310150104024

The surgeon is frequently surprised and dismayed when in the course of upper abdominal surgery the spleen is found to be denuded of a portion of its capsule. This most frequently occurs "spontaneously" at the point where the various tissues or ligaments attach to the spleen at the cephalad or caudad extremes of the hilum. The defect may have been caused by traction on the splenic attachments, and, of course, actual instrumental trauma may have been inflicted upon any portion of the spleen.

When bleeding from a denuded portion of the spleen results in detection of the capsular tear, the surgeon commonly concludes that splenectomy is indicated to prevent possible further hemorrhage in the postoperative period. That is, the diagnosis of splenic injury has often been considered an indication for immediate splenectomy.

In the course of transabdominal repair of an esophageal hiatal hernia, we observed a phenomenon which to us

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