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March 12, 1982

Splenic Trauma, Splenosis, and Death From Sepsis

JAMA. 1982;247(10):1404-1405. doi:10.1001/jama.1982.03320350018006

To the Editor.—  The CLINICAL NOTE "Fulminant Meningococcemia After Splenectomy" by Holmes et al (1981; 246:1119) raises two important issues that deserve further emphasis. First is the danger of overwhelming sepsis in normal adolescents and adults after splenectomy for trauma. Second is the ineffectiveness of intraperitoneal splenic implants (splenosis) in preventing death from fulminant septicemia in asplenic persons.Overwhelming postsplenectomy infection is an unusual but highly distinctive syndrome in which patients who lack splenic function frequently progress from good health to death in less than 24 hours.1 Although the initial symptoms may be mild and nonspecific (headache, fever, malaise, vomiting), the illness rapidly advances and produces convulsions, coma, cardiovascular collapse, and often death. The clinical course resembles the Waterhouse-Friderichsen syndrome, and bilateral adrenal hemorrhages are commonly found at autopsy. Uniquely characteristic of overwhelming postsplenectomy infection is a massive bacteremia. Organisms may be visible in routine smears of unspun peripheral