Splenectomy and sepsis

There is general consensus in accepting that splenic surgery may be associated with significant morbidity and mortality that appears due to an interrelation of circumstances. The most common complications of splenectomy are infectious nature with an incidence of up to 40%; among infections, in 5-7% of cases may occur the so-called overwhelming postsplenectomy infection, motivated by the loss of immune functions of the spleen. In this paper, together with a basic description of the structure and functions of the spleen, the most relevant aspects and preventive measures of this serious postsplenectomy sequel are exposed.

Successful intervention for overwhelming postsplenectomy infection caused by non-vaccine pneumococcal serotype 23A

The spleen plays an important role in the body’s immune defense against invasive infections, particularly those caused by encapsulated bacteria. Encapsulated bacterial infection in asplenic patients is a medical emergency called overwhelming postsplenectomy infection (OPSI) and has a mortality rate of 50–70%. Here, we report the case of a 51-year-old Asian man who complained of emesis and diarrhea as primary symptoms. He rapidly progressed to coma and was eventually diagnosed with OPSI (pyogenic ventriculitis/spondylitis) caused by non-vaccine pneumococcal serotype 23A. Aggressive management, including empiric antibiotic therapy, a staircase approach for intracranial pressure-targeted therapy and laminectomy/laminoplasty, resulted in a good recovery. Our report highlights that non-vaccine pneumococcal serotypes can cause disease in vaccinated patients.