OPSI or spleen salvage

Some 15 years ago we had a severe Crohn’s patient with recurrent fistulae after multiple operations trying to close them. He was for a long period on home parenteral nutrition. Came in with overwhelming systemic pneumococcal infection and died in the classical fashion. It was at the time when OPSI was very much in vogue and we reasoned that perhaps the long-term parenteral nutrion had functionally destroyed his spleen.

Since then I have not encountered another case after splenectomy, but have seen several overwhelming pneumococcal infections due to community acquired pneumonia (in patients with preserved spleens). Dreadful disease.

It seems to me that every generation has its scaring infection. Previously, overwhelming pneumococcal pneumonia or rhematoid fever, then fulminant meningococcal infection, then OPSI, then legionella or staph toxic shock syndrome, and right now the flesh-eating bacteria.

Everybody knows about them, all have seen a few cases at the time when the particular infection is in vogue, then not many more. Who cares about TSS (tampong disease) today. These infections are capable of changing the way societies behave.

The streptococci (including the diplococci) are particularly dangerous because they are human pathogens with a tendency to suddenly express very aggressive pathogenetic factors in which case they invade and produce an overwhelming infection in susceptible individuals.

I have salvaged ruptured spleens after trauma with this net bag made from Vicryl on a few instances. There appears to be price in salvage of smashed spleens in this way as I can remeber two pts with protracted courses for no obvious reason but a badly damage spleen remaining inside the body together with a lot of foreign material. Does anyone have good experiences with the bags?

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