INTRODUCTION: Iatrogenic injury to the spleen is not an uncommon complication. 
Left nephrectomy has been reported as the second commonest cause of iatrogenic 
splenectomy with a reported incidence between 1.3 and 24%. Iatrogenic 
splenectomy is associated with significant morbidity and mortality.
AIMS: We reviewed the occurrence of iatrogenic splenectomy during left 
nephrectomy at our centre. Our aims were to determine the incidence of 
iatrogenic splenectomy within the Mid Yorkshire Hospitals NHS Trust in order to 
understand the nature of the splenic injury and the morbidity and mortality 
associated with it.
METHODS: All splenectomy and nephrectomy histology reports from January 2000 to 
December 2007 were reviewed retrospectively. Indications for splenectomy and 
nephrectomy were identified. Patients' demographic data, tumour characteristics, 
operative details, length of hospital stay and any reported morbidity or 
mortality were collected.
RESULTS: A total of 447 nephrectomies were identified which included 234 left 
nephrectomies. Within the same period 136 cases of splenectomy were performed. 
Thirty-four cases were iatrogenic splenectomies and 12 were caused by left 
nephrectomy. The incidence was 5.13%. The male to female ratio was 1:1 with an 
average age of 66 years. Grade 2 and stage pT2 renal cancer were the commonest 
tumour characteristics. All iatrogenic injuries occurred during mobilisation of 
the colon or division of adhesion. The average operative time was 4.7 h. Average 
length of hospital stay was 14 days. Five patients had postoperative 
complications and 1 died of respiratory failure and sepsis.
CONCLUSION: Splenic injury during left nephrectomy is a morbid complication. A 
good understanding of anatomy and surgical approach may reduce the incidence, 
morbidity and mortality of iatrogenic splenectomy during left nephrectomy.