And unfortunately, you come across a minor splenic capsular tear causing a continuous little by little bleeding. Due to a hard pull of a retractor, or a gross manipulation of the viscera, or just by lack. Do you need to go for a splenectomy or is there anything you can try before?

Well there are a couple of things before you take the spleen out:

First

Put on any kind of glue (i.e. Bioglue, Tisseel), put a gauze on and let it there. Complete the rest of your procedure and come back at the end. Surprisingly, if this a small tear, it may have stopped by then.

Second option

If the glue way has failed try to put on a couple of stitches. Use the long suture used for hepatic injuries with the atraumatic needle tip. Put one gross pass underneath the injury from the one side to the other side of the organ. Pass it through very very gently. Then, cross it backwards on a horizontal “Π” shape. Tie down, very gently. If it is needed, put a second similar suture just beside the first one. In case that you are afraid of tearing the spleen capsule when tying the suture, you can use one pledget from each side.

Wait a little, and flash on the injury site with normal saline. If you do not see any bleeding go on and close the abdomen. If you do see bleeding then probably you have to carry on for a splenectomy.

The various degrees of splenic injury are shown in the following image

AAST spleen injury scale
(source: Jiménez-García AD et al, Rev Med Hosp Gen Mex, 2018;81:35-40)

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