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PubMed1982

Alternatives to splenectomy in adults after trauma. Repair, partial resection, and reimplantation of splenic tissue.

Splenectomy results in a lifelong risk of overwhelming infection in the adult as well as the child. This has prompted our current enthusiasm for splenic salvage in trauma patients. A number of alternatives to total splenectomy exist; however, the complications that result from splenic salvage must not exceed the risk incurred by loss of this organ. Splenorraphy can be performed safely in the majority of patients despite associated intraabdominal injuries. When splenectomy is necessary, reimplantation of splenic tissue is feasible. The efficacy of this technique is preventing postsplenectomy sepsis remains to be established.

Adolescent↗
PubMed1983

Thrombotic thrombocytopenic purpura. Potential benefit of splenectomy after plasma exchange.

Two patients with thrombotic thrombocytopenic purpura (TTP) were treated with a combination of antiplatelet drugs, corticosteroids, and plasma exchange. There was immediate clinical and laboratory improvement in both patients. However, the improvement did not persist following plasma exchange, even with infusions of fresh frozen plasma. Splenectomy was performed on both patients with subsequent sustained remission of the disease. Platelet counts returned to normal within eight days (case 1) and five days (case 2). Follow-up at eight months in one patient and at four months in the other disclosed normal laboratory values with no evidence of recurrent TTP. These cases suggest that in addition to other therapies, splenectomy may be beneficial in some patients.

Adult↗
PubMed1983

The role of splenectomy in Gaucher's disease.

Thirteen patients underwent splenectomy for Gaucher's disease. All patients were Jewish; 12, of Ashkenazi descent, had the chronic (type 1) form, and one child, of Sephardic (Persian) origin, probably had the intermediate (type 3) form. Hypersplenism was the indication for surgery in 11 patients, mechanical problems in the remaining two. The weight of the resected spleens ranged from 1.06 to 13 kg. Following surgery, hypersplenism (thrombocytopenia in particular) was improved, and the mechanical disturbances were relieved in all patients. There were no deaths and no morbidity related to the operative procedure. Long-term follow-up demonstrated progressive hepatomegaly without evidence of hepatic dysfunction in any of the patients. Bone marrow involvement manifested by osteoarticular complications appeared in five patients. Splenectomy is, we believe, a safe mode of treatment for type 1 Gaucher's disease.

Adolescent↗
PubMed1993

Portal vein thrombosis after elective splenectomy. An underappreciated, potentially lethal syndrome.

We describe seven cases of thrombosis of the portal and splenic vein after elective splenectomy. The diagnosis was initially unrecognized in all patients and was confused with biliary sepsis (three cases), postoperative pancreatitis (three cases), or pulmonary emboli (one case). Two patients in whom the diagnosis of portal vein thrombosis was not made within 3 days of disease onset died. In the five survivors, the diagnosis was based on clinical suspicion, confirmed with color flow Doppler ultrasonography or computed tomography with intravenous contrast material, and treated with thrombolytic agents, anticoagulants, and antibiotics. In two patients, splenic vein thrombus was visualized on initial postoperative imaging studies and the thrombus subsequently extended into the portal vein. Portal vein thrombosis should be considered in patients with fever and abdominal complaints after splenectomy. Urgent treatment with thrombolysis and anticoagulants may preserve bowel integrity and be lifesaving.

Aged↗
PubMed1995

Laparoscopic splenectomy. The initial experience at University of California, San Francisco.

OBJECTIVE: To evaluate the outcomes of patients undergoing laparoscopic splenectomy (LS) at a single institution. DESIGN: Case control. SETTING: University teaching hospital. PATIENTS: The medical records of the initial 25 consecutive patients who underwent LS at a single institution were reviewed. For comparison, a control group of 25 patients undergoing open splenectomy (OS) matched for age, diagnosis, and splenic weight were also reviewed. MAIN OUTCOME MEASURES: Data regarding operative time, blood loss, pathologic findings, complications, postoperative hospital stay, ileus duration, preoperative and postoperative hematocrit and platelet counts, blood and platelet transfusions, and hospital costs were collected. RESULTS: Twenty-five patients underwent attempted LS. Four procedures (16%) were converted to OS. Operative time averaged 3.3 +/- 0.2 hours for LS and 2.6 +/- 0.1 hours for OS (P = .001). In the LS group, a regular diet was tolerated 2.1 +/- 0.3 days after surgery (P < .001), and mean postoperative hospital stay was 5.1 +/- 0.6 days (P = .037), compared with 4.3 +/- 0.3 and 6.7 +/- 0.5 days, respectively, in the OS group. No differences were observed in blood loss, complication rate, transfusion requirement, or hospital cost. CONCLUSIONS: Compared with OS, LS requires more operative time, is comparable in blood loss, transfusion requirement, complication rate, and cost, and appears to be superior in terms of return of bowel function and hospital stay.

Adolescent↗
PubMed1978

Leukemic reticuloendotheliosis. Loss of platelet defect after splenectomy.

A 59-year-old woman with leukemic reticuloendotheliosis had pancytopenia and hypersplenism. Before splenectomy, she had an abnormal bleeding time and a severe defect of secondary-wave platelet aggregation. After splenectomy, the platelet count returned to normal, and the aggregation defect was no longer present. This response suggests that the spleen may contribute to the platelet dysfunction.

Blood Platelets↗
PubMed1975

Hypersplenism in advanced breast cancer: report of a patient treated with splenectomy.

A patient with widespread metastatic breast cancer had thrombocytopenia and severe anemia due to splenic hyperfunction, confirmed by chromium51-labeled red cell survival and sequestration studies. Marked splenic enlargement was produced by metastatic tumor. After she failed to respond to steroids, her hematologic status was improved by splenectomy, and has been stable for 16 months. Hypersplenism may be suspected as a cause of severe hemolytic anemia in advanced carcinoma. If the patient's general status is otherwise compatible with long comfortable survival, appropriate diagnostic studies and consideration of splenectomy are warranted.

Anemia↗
PubMed1976

The influence of splenectomy on cellular immunologic parameters in Hodgkin's disease.

Cellular immunity was evaluated in 15 untreated patients with Hodgkin's disease before and about 10 days after splenectomy. Skin test-reactivity was not affected by the operation. The number of lymphocytes was moderately increased in patients with pathologic stage I and II disease. The relative proportion of E-binding lymphocytes in the peripheral blood diminished significantly (p = .001) in patients with splenic weights of 240 g and more, whereas the PHA-stimulated thymidine incorporation increased significantly (p = .015) and the proportion of EAC-binding lymphocytes increased significantly (p = .023). The PHA-stimulation of peripheral lymphocytes in patients with pathologic stage I and II disease was at the same level before and after operation, but increased significantly (less than 0.02) in the more disseminated forms. The stimulation of the lymphocytes in vitro by a cocktail of antigens, and by allogeneic cells (MLC) remained unchanged. Although the number of cases studied is rather small, it is concluded that about 10 days after, splenectomy has no demonstrable untoward effect on the cellular immunologic potency.

Adolescent↗
PubMed1980

Serum immunoglobulin levels in childhood Hodgkin's disease. Effect of splenectomy and long-term follow-up.

Children with Hodgkin's disease had significantly elevated serum IgG and IgA levels but normal IgM and IgD levels when compared with healthy age- and sex-matched controls. The increased serum IgG and IgA levels occurred in all four clinical stages of Hodgkin's disease but were not related to histologic cell type. Following staging splenectomy, serum IgG, IgA, and IgD levels fell by 20% in patients who recieved radiation therapy then returned to preoperative levels; by contrast, serum IgM levels fell by 50% and remained there for at least 36 months. Patients who received chemotherapy had a persistent decline in serum levels of all immunoglobulin classes by at least 40%. Thus, staging splenectomy per se appears to be at least partly responsible for the postoperative decline in serum IgM levels and this effect is enchanced by aggressive treatment of the Hodgkin's disease.

Adolescent↗
PubMed2004

Thromboembolic complications after splenectomy for hematologic diseases.

Thromboembolic complications following splenectomy for hematologic diseases occur in up to 10% of patients and may range from portal vein thrombosis (PVT) to pulmonary embolism (PE) and deep vein thrombosis (DVT). Up to now there exist no recommendations for the duration and intensity of prophylactic anticoagulation, which usually follows local institutional protocols. We report on three consecutive patients with severe portal vein thrombosis and/or pulmonary embolism--one with fatal outcome--7 to 35 days after splenectomy for autoimmune hemolytic anemia, immunothrombocytopenia, and indolent lymphoma, respectively. Incidence and pathophysiology of thromboembolic events (TE) in this patient group as well as prophylactic anticoagulation will be discussed, including a review of the current literature on this topic.

Adult↗
PubMed2006

Splenic cord capillary hemangioma and anemia: resolution after splenectomy.

A 59-year-old female presented with isolated anemia and a splenic mass. Standard histology and immunohistochemical techniques categorized the splenic lesion as a cord capillary hemangioma. The patient's anemia resolved following splenectomy. Cord capillary hemangiomas are exceedingly rare with few reports in the literature. This is the first reported case of resolution of anemia after splenectomy for a vascular tumor of the spleen.

Anemia↗
PubMed1981

Primary splenic hairy cell leukemia--remission for 21 years following splenectomy.

A patient with primary splenic hairy cell leukemia is reported. This patient presented with massive splenomegaly and pancytopenia due to hypersplenism. Exploratory laparotomy failed to demonstrate any disease outside the spleen and splenic hilar lymph nodes. Splenectomy was the only form of treatment. During the following 21 years, no recurrent hairy cell leukemia has been found. This case allows speculation that hairy cell leukemia may originate in the spleen and that prolonged survival or cure of the disease after splenectomy alone may be due to removal of stem cells in the spleen.

Bone Marrow↗
PubMed1983

Splenectomy for thrombocytopenia in chronic lymphocytic leukemia.

The role of peripheral platelet destruction as a reversible etiology of thrombocytopenia in chronic lymphocytic leukemia (CLL) was evaluated in nine patients with CLL and refractory thrombocytopenia who underwent splenectomy. The patients' ages ranged from 54 to 74 years. Progressive thrombocytopenia refractory to antineoplastic agents and corticosteroids had been present for a mean of 23.4 months. The platelet counts were 4,000-57,000/microliter, and were generally higher in those patients with larger spleens. The spleens ranged from 180 to 4050 gm. Seven patients responded completely to splenectomy, achieving platelet counts greater than 150,000/microliter, and in one other patient, the count rose to greater than 100,000/microliter. The platelet count of one patient failed to respond to surgery. Those patients with massive splenomegaly developed higher, more rapidly rising platelet counts postoperatively. No operative mortality was encountered. Median hospitalization was seven postoperative days. All patients experienced an increased sense of well-being. Median follow-up time is 9 months.

Aged↗
PubMed1989

Apparent response of refractory post-transfusion purpura to splenectomy.

Post transfusion purpura (PTP) is a rare disorder characterized by the abrupt onset of severe thrombocytopenia following transfusion. A patient with PTP and massive bleeding was refractory to corticosteroids, gamma globulin, and plasma exchange but developed an immediate and sustained rise in platelet count following splenectomy. Splenectomy may be a useful therapeutic modality in patients with refractory PTP.

Aged↗
PubMed1991

Circulating nucleated red blood cells following splenectomy in a patient with congenital dyserythropoietic anemia.

A 24-year-old white female with a 10-year history of juvenile rheumatoid arthritis and splenomegaly developed numerous circulating nucleated red blood cells (NRBC) following splenectomy for chronic abdominal pain. Subsequent evaluation revealed the presence of a congenital dyserythropoietic anemia (CDA) with atypical features. Circulating NRBCs have been reported following splenectomy in three other cases of CDA, each of which had atypical features and did not fit into the customary classification of types I-IV. Follow-up of our patient at 4 years revealed no untoward consequences of persistent NRBCs in her circulation.

Adolescent↗
PubMed1995

Significant and persistent improvement of thrombocytopenia after splenectomy in an adult with the Wiskott-Aldrich Syndrome and intra-cerebral bleeding.

The Wiskott-Aldrich syndrome is an X-linked inherited immunodeficiency disorder characterized by thrombocytopenia, recurrent infections and eczema. Its best management option is HLA-identical bone marrow transplantation; when this is not feasible, splenectomy, followed by continuous prophylactic antibiotics, represents the alternative of choice. The present case report relates the excellent outcome of an adult with the Wiskott-Aldrich syndrome who suffered his first major complication of the disease at age 33 years, an intracerebral hemorrhage. Since an uneventfull splenectomy, thrombocytopenia has significantly improved, and he has remained free of infections for a follow-up period of 3 years while being treated with prophylactic antibiotics.

Adult↗
PubMed1982

Segmental splenectomy in schistosomiasis.

Segmental splenectomy was performed in 5 patients with hepatosplenic schistosomiasis mansoni and symptomatic splenomegaly. The aim was to preserve a functional remnant comprising 20-30 per cent of the bulk of a greatly enlarged spleen. The operative technique involved devascularization of anatomic segments and suture of an omental patch to the residual spleen. This procedure was simple, well tolerated and effective in relieving abdominal discomfort and cytopenias. The residual spleens showed normal uptake of 99Tc-sulphur colloid. If long term observation confirms the value of segmental splenectomy in hepatosplenic schistosomiasis, it may become appropriate therapy for those patients with symptomatic splenomegaly who do not require portal decompression.

Adolescent↗
PubMed1983

Splenectomy and infection in Hodgkin's disease.

The incidence of infection in 56 patients with Hodgkin's disease who had undergone staging laparotomy with splenectomy was compared with that of 28 non-splenectomized patients with Hodgkin's disease treated concurrently. The results suggest that splenectomy does not result in a major change in the incidence of infection experienced by such patients with stage II or stage III disease. Aggressive therapy may be of greater importance in increasing the susceptibility to infection in Hodgkin's disease.

Adolescent↗