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A Journal on Forensic Medicine
Minerva Medicolegale 2007 September;127(3):231-6
Streptococcus pneumonite severe sepsis after splenectomy. A review of the mean international prophylactic recommendations on the basis of a case report
De Salvia A., Lanzara G., De Leo D.
Division of Forensic Medicine Department of Medicine and Public Health University of Verona G.B. Rossi Polyclinic, Verona
Asplenia and hyposplenism are not uncommon conditions in the general population, counting for about 5 000 in the Veneto Region population of 4 500 000 people. Congenital asplenia is quite rare, but functional hyposplenism due to hematological diseases (sickle cell anemia, thalassemia, lymphoproliferative neoplasms …), gastro-enteric diseases (celiac disease, liver diseases with portal hypertension …), immunologic diseases (sarcoidosis, Felty’s syndrome…) or storage disease (Gaucher’s disease …), abdominal irradiation, or surgical removal of the spleen as an emergency procedure or elective surgery for malignancies or splenic cyst or malformations are actually more frequent in the general population. As in adults the hemocatheretic function can be carried out by other organs and there is no need for splenic hemopoiesis, the principal awareness after surgery is immunologic dysfunction. It is well documented that removing the spleen leads to an increased lifelong risk of sepsis from capsulated bacteria so that preventive strategies such as vaccinations against these micro-organisms, or, as an alternative, daily antibiotic administration are recommended in all splenectomized patients. This is a steady quotation in medicine, nevertheless some still forget to protect patients from the possible dramatic epilogue. We report a non fatal case of bacterial sepsis occurring seven years after splenectomy in a non-vaccinated patient.