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PubMed1993

The influence of splenectomy on infective morbidity after colonic and splenic injuries.

OBJECTIVE: To establish the incidence of early postoperative infections after civilian injuries to the spleen, colon, or both and assess the effect of splenectomy on outcome. DESIGN: Retrospective study of case notes. SETTING: University hospital. SUBJECTS: 403 Patients of whom 353 had splenic injuries, 91 with associated colonic injuries, together with 50 randomly selected patients with colonic injuries alone. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: 45 Patients had splenectomy and colonic injury (group 1), 46 had a colonic injury and the spleen conserved (group 2) 50 had colonic injury alone (group 3), 143 had splenectomy for injured spleen without colonic injury (group 4), and 119 had the spleen injured and conserved without colonic injury (group 5). Their mean age was 28 years. Overall mean Injury Severity Score (ISS) was 30.1, and Abdominal Trauma Index (ATI) 22.4. 68/403 died (17%), more than half within 48 hours. Early mortality was higher in both groups in which the spleen was removed but after stratification by ISS and ATI the differences were not significant. Late mortality (after 48 hours) associated with sepsis did not differ significantly among the groups, nor did the rate of infective complications. Mechanism and severity of injury had the most influence on morbidity and mortality. CONCLUSION: Removal of an injured spleen does not have an adverse influence on the incidence of serious infective complications in the early postoperative period in patients with injuries to the spleen, the colon, or both.

Adult↗
PubMed1993

[Splenectomy for splenic abscess caused by Salmonella typhi].

Splenectomy due to splenic abscess is without doubt an unusual occurrence, especially in Western countries. The paper reports the case of 19-year-old male who underwent splenectomy because of an abscess caused by Salmonella typhi. Following a revision of the literature it appears that only six cases of splenic abscess by S. typhi have been reported since 1940. Splenectomy represents the elective treatment for patients with splenic abscess provoked by any cause.

Abscess↗
PubMed1993

Subtotal splenectomy and portal variceal disconnection in the treatment of portal hypertension.

Bleeding gastroesophageal varices caused by portal hypertension can be treated successfully by subtotal splenectomy and central splenorenal shunting. However, in elderly patients and those at high risk of hepatic failure, congestive heart failure and encephalopathy or when splenorenal anastomosis is impossible, an alternative is subtotal splenectomy and portal variceal disconnection. The author reports on the first nine patients who underwent this procedure and describes the operative technique. Complications of the operation were minimal. One patient had thrombocytosis, but this was controlled clinically. No patient experienced encephalopathy during a follow-up ranging from 10 months to 8 years. No rebleeding was noted in seven of the patients, but two had a bleeding duodenal ulcer, which was treated successfully. Liver function was preserved in all patients. These results have encouraged the author to continue investigation of subtotal splenectomy and portal variceal disconnection.

Adolescent↗
PubMed1993

Laparoscopic splenectomy in the management of immune thrombocytopenia purpura.

The role of splenectomy in the management of immune thrombocytopenia purpura is well known. Recent improvements in laparoscopic technology have significantly expanded the variety of general surgical procedures amenable to a minimally invasive approach. An initial experience of four cases of immune thrombocytopenic purpura managed by laparoscopic splenectomy is presented. The entire procedure was completed under laparoscopic guidance in three of four cases, and a counterincision was required to control bleeding in one patient. The procedure is performed with five operating ports including a camera port, two retraction ports, and two dissection ports. Dissection begins at the lower pole of the spleen and progresses cephalad to the hilum where major vessels are individually ligated and divided. The short gastric vessels are divided with a linear laparoscopic stapler. The lateral peritoneal attachments are divided, and the spleen is removed intact through a 6 cm fascial incision at the umbilicus. Laparoscopic splenectomy appears to be a safe and efficacious procedure that is useful in the management of certain hematologic diseases and may ultimately be performed for a variety of pathologic conditions involving the spleen.

Adult↗
PubMed1993

Splenectomy does not enhance engraftment of DLA-nonidentical marrow transplants.

Previous studies in mice and monkeys suggested that either splenic irradiation of splenectomy led to enhanced allogeneic marrow engraftment. These findings suggested that a population of radiation-resistant host cells involved in mediating marrow graft rejection are sequestered in the spleen. In this current study, the effect of splenectomy in dogs receiving 9.2 Gy total body irradiation (TBI) and unrelated dog leukocyte antigen (DLA)-nonidentical donor marrow grafts was studied. We found that splenectomy did not significantly change the incidence of graft failure as compared to that observed in previously and concurrently transplanted nonsplenectomized recipients.

Animals↗
PubMed1995

Laparoscopic splenectomy. Technique and results in a series of 27 cases.

Between early 1992 and December 1994, laparoscopic splenectomy was performed in 27 patients with idiopathic thrombocytopenia (ITP), hairy-cell leucemia, HIV, or Hodgkin's disease. In all cases medical treatment, especially cortisone therapy, failed. In Hodgkin's disease the splenectomy was combined with liver biopsies and dissection of parailiacal, paraaortic, and mesenteric lymph nodes for abdominal staging. The operation was performed using four trocars; the splenic vessels were divided by a linear stapler. In general the spleen was removed in a bag through a slightly enlarged trocar incision or after morcellation. Three patients needed a small laparotomy for the removal (laparoscopic assisted). In a recent case of Hodgkin's disease the intact spleen was removed via posterior colpotomy. In 22 of 27 cases (81%) the operation was finished laparoscopically. Five times a conversion to conventional laparotomy was necessary because of bleeding of enlarged lymph nodes at the hilum. Wound infections occurred in two cases. In one patient with ITP the platelet count did not improve and continuous blood loss led to relaparotomy at the 1st postoperative day. No surgical bleeding was found. All patients tolerated a fluid diet at the 1st postoperative day and hospitalization time was 4.4 days (range 3-14). Regarding the low complication rate and the advantages of a smaller abdominal trauma in the postoperative period, the laparoscopic approach for elective splenectomy and laparoscopic abdominal staging has a substantial benefit for the patients.

Adolescent↗
PubMed1995

[Splenectomy under celioscopy].

Laparoscopic splenectomy has been extensively developed since its first description by Delaître in 1991. From May 1993 to July 1994, 12 patients underwent laparoscopic splenectomy in the "service de Chirurgie C" of the "CHU de Nancy". Six of them were successful. 6 women with a mean age of 27.7 years. The mean operating time was 2 h 30 min. For all cases, the indication was idiopathic thrombocytopenic purpura. No mortality and no morbidity was reported. One patient needed a blood transfusion. The postoperative stay ranged from 3 to 7 days. Splenectomy appears to be another procedure that may be successfully performed under laparoscopic guidance with satisfactory conditions of safety. The outcome evaluation should be continued in order to accurately define the real advantages and risks of this new technique.

Adolescent↗
PubMedDate not supplied

[Accessory spleen: compensating hypertrophy after of splenectomy. A case report].

The prevalence of accessory spleens has been reported to be about 7.1% in infants. When these patients undergo splenectomy without removal of the accessory spleen, the latter develop hypertrophy later in life and can reach the size of a normal spleen, with clinical manifestations similar to the ones before surgery. We report the case, of fourteen-old boy, who had splenectomy 7 year ago, for refractory and recurrent thrombocytopenia, who had splenectomy at age 7 years because of persistent thrombocytopaenia, resistant to non-surgical treatment, and who was found by conventional ultrasound study, doppler duplex color and selective angiography to have a hypertrophied spleen with sings of portal thrombosis and portal hypertension.

Adolescent↗
PubMed1977

A micro-method for PHA-induced stimulation of human lymphocytes. II. communication: effect of splenectomy on the inhibitory activity of serum in patients with Hodgkin's disease.

Lymphocytes of 19 unselected patients with Hodgkin's disease were stimulated with PHA in vitro using a microculture system. The sera of these donors were simultaneously tested for their ability to support PHA-induced stimulation of normal lymphocytes as compared to sera drawn from healthy volumteers. Wheras DNA synthesis in Hodgkin's disease using normal sera was almost uniformly decreased, transformation of normal lymphocytes was suppressed in 9 of 11 sera from patients with Hodgkin's disease without splenectomy, but only in 1 of 8 sera from patients tested after removal of the spleen. 3 donors could be tested both before and after splenectomy, 2 showed a complete disappearance of inhibiting substances in their sera. These findings are discussed as to the immunological significance of inhibiting factors and splenectomy in Hodgkin's disease.

Hodgkin Disease↗
PubMed1995

Post-splenectomy lymphocytosis.

We describe post-splenectomy lymphocytosis (PSL) in 23 patients, a majority (20/23) of whom have undergone splenectomy as a staging procedure for Hodgkin's disease. The absolute lymphocyte count ranged from 4.0 to 8.7 x 10(9)/l. The lymphocytosis was noted 4-242 (median 70) months after splenectomy and persisted almost unchanged in most patients on prolonged follow up (median 50 months). Immunophenotyping of the lymphocytes revealed no monoclonal B cell population.

Adult↗
PubMed1977

Effects of neonatal thymectomy and splenectomy on survival and regulation of autoantibody formation in NZB/NZW F1 mice.

NZW F1 (B/W) mice were subjected to sham surgery or neonatal thymectomy and/or splenectomy and studied for immunoglobulin class of antibodies to double-stranded DNA and polyadenylic acid (Poly A) at 4 to 13 months of age. These antibodies occur spontaneously during the course of autoimmune disease in B/W mice. Sera were fractionated by sucrose density gradient ultracentrifugation and assayed for antibodies by a filter radioimmunoassay method. IgM was recovered in the 19S region and IgG in the 7S region as demonstrated by immunodiffusion. In sham-operated controls, at all ages studied, anti-DNA antibodies were both IgM and IgG, with the former predominating in males, and the latter in females. In both sexes, anti-Poly A antibodies were primarily IgM in young mice. There was a sequential switch from IgM to either enhanced or new IgG production in the following sequence: female anti-DNA and anti-Poly A (6 months), male anti-DNA (9 months), and male anti-Poly A (11 months). Both thymectomy and splenectomy caused earlier death in male mice, whereas females lived significantly longer after thymectomy. Neonatal thymectomy in males caused a premature switch from IgM to IgG antibodies to DNA, but it had a transient effect in females. Thymectomy almost completely prevented the late switch to IgG antibodies to Poly A in both sexes. By contrast, splenectomy promoted the formation of IgG antibodies to Poly A in male mice. These results suggest that the newborn B/W thymus and spleen contain regulatory cells and/or factors exerting different controlling influences on spontaneous antibodies to DNA and Poly A. Male B/W mice appear to be under the regulatory influence of suppressor cells, whereas the predominant regulation in female B/W mice appears to be a helper effect.

Age Factors↗
PubMed1996

Nephrotic syndrome associated with chronic lymphocytic leukemia resistant to immunosuppressive drugs: remission obtained by splenectomy.

Chronic lymphocytic leukemia is a common disease in the elderly but is rarely associated with a nephrotic syndrome. The rarity of this association suggests that leukemic cells may have certain properties or features that may lead to the development of glomerulonephritis. Effective medical treatment of the leukemia may not necessarily allow regression of the nephrotic syndrome; however, the effects of splenectomy on nephrotic proteinuria when associated to chronic lymphocytic leukemia have never been evaluated. We report the case of a 50-year-old male with stage C CD5+ chronic lymphocytic leukemia associated with a nephrotic syndrome due to Type I membranoproliferative glomerulonephritis. Chlorambucil and prednisone were unable to control the leukemia and the nephrotic range proteinuria, and were discontinued because of poor hematologic tolerance. A splenectomy immediately resulted in a spectacular remission of both chronic lymphocytic leukemia and the nephrotic syndrome. Spleen lymphocytes were collected and tested in quantitative flow cytometry for the expression of the main B cell associated markers. They did not exhibit any particular immunophenotypic pattern. This report of a remission of a glomerulonephritis associated with chronic leukemia following splenectomy is evidence of a possible relationship between the two diseases.

Glomerulonephritis, Membranoproliferative↗
PubMed1996

[Is splenectomy "en principe" necessary for radical gastrectomy with systematic lymphadenectomy?].

SUMMARY: In order to screen the necessity of splenectomy "en principe" we evaluated all patients suffering from gastric carcinoma between Jan. 1988--Apr. 1993 retrospectively. In total a group of 318 patients were treated and from these 261 patients were operated (resection rate 82%). In 30% of the patients (77 pat.) we performed a subtotal distal gastrectomy and in 70% (184 pat.) a radical gastrectomy with a D 2-lymphadenectomy. The splenectomy rate in the group of gastrectomy was 94% (173 pat.). In total 13% of the lymph nodes of the hilus of the spleen were infiltrated and an additional metastasis of the spleen was found in 1%. In carcinomas located at the minor curvature 13% had an infiltration of the lymph node station 10, in carcinomas located at the greater curvature in 17% and in carcinomas with a diffuse tumor growth in 10% respectively. Patients with a tumor located in the proximal stomach had an infiltration of the lymph nodes in 14% and in carcinomas of the antrum in 7% respectively. None of the patients having a UICC stage I/II had an infiltration of the lymph nodes at the hilus of the spleen, but 25% of the patients having a UICC stage III/IV. 2 patients from the latter group had an additional metastasis of the spleen. CONCLUSION: The indication of splenectomy is given only in advanced proximal tumor locations, especially in tumors of the greater curvature. In the early tumor stages and in the distal locations of gastric carcinoma it might be useful to perform a selective lymph node dissection of the hilus of the spleen in order to increase the completeness of the radical gastrectomy.

Gastrectomy↗
PubMed1996

Laparoscopic splenectomy: preliminary experience.

The role of conventional open splenectomy in the treatment of idiopathic thrombocytopenic purpura (ITP) is well known. As improvement in laparoscopic instruments and techniques have been made, laparoscopic surgery has been significantly extended to include more general surgical procedures. From July 1993 to March 1995, five patients with refractory ITP were treated by laparoscopic splenectomy at National Taiwan University Hospital. The entire procedure was completed under laparoscopic guidance in which four ports were used in four of the five cases. The operative time for these four patients ranged from 180 to 330 minutes with an average time of 225 minutes. The estimated blood loss ranged from 100 to 400 mL with an average of 175 mL. No intraoperative blood transfusions were required. A Penrose drain was in place for 2 to 3 days. All of the patients were able to tolerate a regular diet within 1 postoperative day. The average postoperative hospital stay was 5.25 days. No complications occurred. The remaining laparoscopic surgery was unsuccessful, requiring conversion due to severe bleeding. In conclusion, laparoscopic splenectomy is a feasible and safe procedure for patients with ITP. It may be an alternative choice for a variety of hematologic and pathologic conditions involving the spleen.

Adolescent↗
PubMedDate not supplied

Splenic marginal zone cell lymphoma involving liver and bone marrow. Report of a case with protracted follow-up, showing progressive disappearance of the lymphoma after splenectomy.

We report the case of a 42-year-old man who presented with B-symptoms, moderate splenomegaly and multiple nodules in the liver. Histologically, lymphocytic infiltrates were seen in the portal spaces and sinusoids of the liver and in the paratrabecular areas of the bone marrow. After excision, the spleen showed minimal disturbance of architecture with an expansion of the follicular marginal zones. These findings were considered inconclusive for lymphoma and the patient was treated only with non-steroidal anti-inflammatory drugs for persisting fever. Five months after splenectomy, a bone marrow biopsy still showed diffuse lymphoid infiltrates. From then on, the patient's condition improved with no further evidence of disease. Ten years after splenectomy the case was reconsidered as a splenic marginal cell lymphoma, indolent variant. Immunohistochemical and gene rearrangement studies demonstrated the monoclonality of the splenic proliferation, supporting the diagnosis. A further bone marrow biopsy did not detect residual lymphoid infiltrates. This case confirms that splenic marginal zone cell lymphoma may have a deceptively favorable course, even when presenting at an advanced stage. Moreover, it indicates that extrasplenic localizations of the lymphoma may persist for a long while after splenectomy but may vanish over time without therapy.

Adult↗
PubMed1996

[Simultaneous mitral valve replacement and splenectomy in a patient with chronic idiopathic thrombocytopenic purpura].

A 57-year-old female with valvular heart disease and chronic idiopathic thrombocytopenic purpura (ITP) underwent successful open-heart surgery. Preoperative administration of steroids and high-dose gamma-globulin increased the platelet count from 3 x 10(4)/microgram at admission to 10 x 10(4)/microgram before the operation. Splenectomy followed by mitral valve replacement (SJM 27M) were performed simultaneously. No platelet transfusion needed during and after the operation owing to rapid increase in platelets that would occur following splenectomy. The postoperative course was uneventful. The present simultaneous splenectomy and open-heart operation appears to be a safe and effective procedure for minimizing perioperative blood loss in patients with ITP and heart disease.

Chronic Disease↗
PubMed1995

Adult idiopathic thrombocytopenic purpura without the option of splenectomy.

In this part of Malaysia, consent of splenectomy is virtually unobtainable, so we studied the outcome of ITP without this treatment option. Thirty-two adult patients were seen, but 7 defaulted before therapy evaluation. Of the remaining 25, 17 achieved a complete remission with prednisolone, but in only 8 was this prolonged. Twelve patients, who failed to respond to prednisolone or who required > 15 mg/day as maintenance, were offered splenectomy, but all fused. Of these 12: one has died from an intracranial haemorrhage; three others have defaulted while on no treatment with platelet counts of < 16 x 10(9)/1; one has had a baby who died from intracranial bleeding. The other seven patients have platelet counts ranging from 4 - 202 x 10(9)/1 with moderate bleeding on doses of prednisolone of 0-60 mg/day: long-term corticosteroid side-effect are evident in all but one of them. This study demonstrates that ITP patients who refuse splenectomy have a high morbidity.

Adolescent↗
PubMed1977

The avoidable complications of splenectomy.

Operative injury to the spleen and consequent accidental splenectomy is neither an infrequent nor an inconsequential occurrence. It still accounts for 25 per cent of all splenectomies performed. The morbidity rate resulting from this accident is well above 50 per cent, and the mortality may be as high as 15 per cent. Appreciation of the peritoneal anatomy of the spleen with prophylactic division of the splenoperitoneal folds will lessen the incidence of capsular avulsion injuries. When capsular avulsion injuries do occur, they may be effectively treated with topical hemostatic agents, such as microfibrillar collagen, Avitene. Twenty-one instances in which splenectomy for capsular avulsion injury was averted have been reported. In the last 15 of these, the topical hemostatic agent used was Avitene.

Collagen↗