The Editors welcome topical correspondence from readers relating to articles published in the Journal. Responses should be sent electronically via the BJS website (www.bjs.co.uk). All letters will be reviewed and, if approved, appear on the website. A selection of these will be edited and published in the Journal. Letters must be no more than 250 words in length.
Systematic review of atraumatic splenic rupture (Br J Surg 2009; 96: 1114-1121)
Sir
We would like to thank Mr Renzulli and colleagues, who put their best efforts into this systematic review of atraumatic splenic rupture (ASR). However, a few points need clarification.
The authors defined survivors as those who died from underlying disease within 30 days of follow-up or during the hospital stay. Death within 30 days or in hospital means failure of the treatment unless the patient died from an unrelated cause. Those dying in hospital or within 30 days cannot be included in the survivor group as it will not be possible to judge the efficacy of different treatment modalities and this may have a significant impact on the ASR-related mortality. Considering this 30-day criterion, the statistical analysis of ASR-related death cannot be correctly compared with the type of treatment modality.
In discussing diagnostic procedures, the authors have not highlighted the sensitivity and specificity of any diagnostic procedures. Ultrasonography was positive for free fluid in 24•6 per cent of patients compared with computed tomography in 23•0 per cent. We think this is a wrong interpretation of the collected data as this suggests that ultrasonography is more sensitive for free fluid. Similarly, peritoneal lavage was positive in 89 patients (10•5 per cent); does this mean that peritoneal lavage done in almost all patients? 1 The data are presented in an ambiguous manner.
In the discussion of treatment, the tabulated data do not match the written data. The mortality in the primary non-surgical group (five patients) also needs to be described in detail. Were these deaths in patients who underwent splenectomy because of rebleeding or who completed primary non-surgical treatment?