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December 1976

Splenectomy for Trauma: A Second Look

Arch Surg. 1976;111(12):1325-1326. doi:10.1001/archsurg.1976.01360300015001

Skepticism in surgery is a healthy philosophy. It leads to the questioning of principles that might formerly have been regarded as absolute and sacrosanct. Especially is such skepticism commendable if it leads to the modification of a form of treatment toward a less invasive alternative, provided always that the ensuing result is at least as good as that which previously had been obtained.

The anatomy of the spleen is well known to surgeons. As well known is its propensity for injury in abdominothoracic trauma, its peculiar vulnerability in its immediate relationship to the overlying three ribs, and the sometimes catastrophic hemorrhage following laceration. Equally widespread is the certain knowledge that splenectomy is the treatment of choice. "Once the diagnosis is made or even highly suspected, laparotomy is indicated."1 This teaching is universal and generally accepted.

However, at the Hospital for Sick Children in Toronto, it has not been our