95 - Overwhelming Postsplenectomy Infection

Summary

What more thou didst deserve than in thy name,

And free thee from the scandal of such senses

As in the rancor of unhappy spleen

Measure thy course of life, with false pretenses

Comparing by thy death what thou hast been.

–“A Funeral Elegy,” W. Shakespeare, 1612

INTRODUCTION

The human spleen (Figure 95.1) (in German: milz; ohnemilz: without a spleen), an organ that at one point had been deemed as nonessential as the appendix, has been associated in history as the source of melancholy thoughts. This concept brought forth the expression of “venting one's spleen” as a way of improving a person's overall situation. A similar therapeutic process, laughter (“If you desire the spleen, and will laugh yourself into stitches, follow me,” Shakespeare [Figure 95.2A], Twelfth Night, Act III, Scene 2), is also linked to the spleen.

It seems ironic, therefore, that these concepts reflect that this collection of immune cells in the left upper quadrant of the abdomen appeared to function as a way of cleansing the body. Indeed, Shakespeare's “unhappy spleen,” one that has been removed from residence (by splenectomy) or whose function is embarrassed by one or another disease (hyposplenism), predisposes (by not appropriately performing its cleansing function) its former owner to an infectious disease process with substantial morbidity and mortality by becoming ohnemilz.

This disease, overwhelming postsplenectomy infection (OPSI), also referred to as postsplenectomy sepsis (PSS), is one of a group of infectious disease processes, such as bacterial meningitis and meningococcemia, for which diagnosis and therapeutic intervention are required immediately to minimize the disease impact.