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PubMed1999

[Portal and superior mesenteric vein thrombosis after splenectomy for idiopathic thrombocytopenic purpura].

Mesenteric and portal vein thrombosis are rare complications of splenectomy. Their presentation depends on the underlying disease. It is most frequent in lymphoproliferative disorders but extremely rare in trauma. We describe a 22-year-old man and a 49-year-old woman who underwent splenectomy for idiopathic thrombocytopenic purpura and developed mesenteric and portal vein thromboses. Both were treated successfully with anticoagulants for 3 months until the thrombi regressed, as shown by CT scan. During a year of follow-up they were asymptomatic.

Adult↗
PubMed2000

[Successful treatment of refractory thrombotic thrombocytopenic purpura with cyclosporine A and splenectomy].

A 19-year-old girl was admitted to our hospital because of general fatigue, headache and purpura. A number of her laboratory findings suggested hemolytic anemia and thrombocytopenia. Direct/indirect Coombs tests gave negative results. Although the patient had no neurological or renal abnormalities, peripheral blood smears showed marked red cell fragmentation, and therefore she was diagnosed as having thrombotic thrombocytopenic purpura (TTP). Fresh frozen plasma (FFP) was transfused daily. The thrombocytopenia and hemolysis immediately improved, but worsened again after reduction of the FFP transfusion. Plasma exchange was instituted every other day, but the patient's condition worsened. Palsy and consciousness disturbance developed, and finally she lapsed into a coma. Daily plasma exchange and methylprednisolone pulse therapy were performed, together with weekly vincristine therapy, and this led to a gradual improvement in the patient's condition. However, several attempts at weaning from plasma exchange resulted in exacerbation of the TTP activity. Therefore oral cyclosporine A was started and splenectomy was performed. After these interventions, despite transient relapse, the patient was successfully weaned off the FFP transfusion, and she is now in remission. Because in this case splenectomy and cyclosporine A resulted in sustained remission of TTP that was refractory to intensive plasma therapy, an autoimmune mechanism may have been involved in the pathogenesis.

Adult↗
PubMed2000

Laparoscopic versus open splenectomy: a comparative study.

Laparoscopic splenectomy (LS) is gaining wide acceptance as a safe, effective alternative to open splenectomy (OS) in the treatment of hematologic disorders in adult and pediatric patients, with low conversion rates and complications. The aim of this retrospective case-control study was to compare two cohorts of patients, with similar characteristics, who underwent OS or LS in a single institution. The medical records of the initial 20 consecutive patients who underwent LS were reviewed and compared with a control group of 28 patients undergoing OS, matched for age, gender, diagnosis, splenic size and weight, and American Society of Anesthesiologists score. Data were collected regarding operative time, blood loss, blood transfusions, pathologic findings, accessory spleen detection, complications, ileus duration, and postoperative hospital stay. Nineteen patients underwent attempted LS. One procedure (5%) was converted to OS for uncontrolled hilar bleeding. Accessory spleens were detected in two cases in the LS group compared with four cases in the OS group (14%). Mean operative time was 165 minutes (range: 100-240 minutes) for LS and 114 minutes (75-180 minutes) for OS (P < 0.001). In the LS group a regular diet was tolerated 36 hours (range: 24-48 hours) after surgery compared with 72 hours (range: 48-96 hours) for the OS group (P < 0.001), and mean postoperative hospital stay was 4.1 days (range: 3-8 days) for LS, compared with 8.1 days (range: 5-12 days) for OS (P < 0.001). No differences were observed in blood loss, complication rates, or transfusion requirements. Compared with OS, LS requires more operative time (showing a learning curve), is comparable in blood loss, transfusion requirements, complication rates, and detection of accessory spleens and appears to be superior in terms of return of bowel function and hospital stay.

Adolescent↗
PubMed2000

Laparoscopic splenectomy in children with hematological disorders: preliminary experience at the Children's Hospital of New Orleans.

Minimally invasive surgery has recently gained acceptance as the surgical approach of choice for a variety of surgical disorders in children. Although traditional open surgery is still regarded as the standard approach for a splenectomy in children when necessary for hematologic disorders a few cases of successful laparoscopic splenectomy (LS) have been reported. We present our initial 11 cases of LS in children assessing surgical outcome. Eleven patients ages 2 through 15 years underwent LS between June of 1996 and July of 1999 at the Children's Hospital of New Orleans. Indications for surgery included idiopathic thrombocytopenic purpura, congenital spherocytosis, and hemolytic anemia. In all patients the diameter of the spleen was less than 15 cm. Surgical outcome was assessed according to the following parameters: operative time, postoperative length of stay, postoperative morbidity, and cosmetic results. Data were accumulated on the basis of retrospective chart review. LS was completed in all 11 patients. Postoperative morbidity was minimal and the median postoperative stay was 2.4 days (range 1-5). Mean operative time was 3 hours and 10 minutes (range 1.5-7 hours) with the last six procedures completed in an average of just over 2 hours. Intravenous analgesia was discontinued in <48 hours in all patients. Cosmetic results were judged excellent in all cases. We conclude that LS was safe in children with certain hematologic disorders. Adequate selection of patients, appropriate preoperative preparation of patients, meticulous surgical technique, and careful postoperative care were key factors in obtaining the same long-term results as with open surgery.

Adolescent↗
PubMed2001

[Mixed-type autoimmune hemolytic anemia after splenectomy for idiopathic thrombocytopenic purpura].

A 30-year-old woman was admitted because of anemia and jaundice in 1999. She had been diagnosed as having idiopathic thrombocytopenic purpura (ITP) in 1996, but had shown no response to prednisolone (PSL). Subsequent splenectomy in 1998, followed by further treatment with PSL, had also been ineffective. On admission in 1999, the direct and indirect Coombs tests gave positive results, the cold agglutinin titer was high with anti-I specificity (IgM), and warm-type autoantibody (IgG) was positive. Autoagglutination of the patient's red blood cells was 3+ at 37 degrees C. A diagnosis of mixed-type autoimmune hemolytic anemia (AIHA) associated with ITP was made. Mixed-type AIHA occurring after splenectomy for ITP is very rare, only one case having been reported to date.

Adult↗
PubMed2001

The degree of bone marrow infiltration in patients with hairy cell leukemia treated with splenectomy compatible with long-term hematological remission.

To determine the degree of bone marrow infiltration with hairy cells which is compatible with long-term hematological remission in patients treated with splenectomy, we have investigated 7 patients surviving in hematological remission 61 to 255 months (median 184 months) after splenectomy. As hematological remission has been considered absence of hairy cells (HCs) in the peripheral blood, normalization of peripheral blood cell counts (hemoglobin 120 g/l, white cell count 4.0 x 10(9)/l, absolute granulocyte count 1.5 x 10(9)/l, platelet count 100 x 10(9)/l) and absence of lymfadenopathy and any other activity of the disease. For detection of HCs a very sensitive method of immunostaining with monoclonal antibody DBA.44 in our own modification has been used. Low values of sIL-2R which is considered to be a non invasive marker of tumor burden and activity in HCL were in agreement with the opinion that the bone marrow was the only locality of tumor involvement in splenectomized patients. Infiltration up to 20% with HCs (range 4% to 20%, median 10%) was found to be compatible with long-term hematological remission and long-term overall survival. Patient (No 1) with 30% infiltration of bone marrow with HCs, still normal peripheral blood cell counts, but a very high level of sIL-2R represents extraordinary finding which has been discussed in details.

Adult↗
PubMed2001

Thrombocytopenia caused by splenic hamartoma: resolution after splenectomy.

We report a rare case of isolated thrombocytopenia due to a large hamartoma of the pulposal type, which resolved with splenectomy in a 46-year-old man. Although hamartomas are usually found incidentally, they may cause hematologic disturbances such as thrombocytopenia, anemia, or splenic rupture. The diagnosis of splenic hamartoma is difficult to make preoperatively. Splenectomy is important in excluding malignant tumors from the diagnosis when the etiology of a splenic mass is unclear and ameliorating hematologic symptoms related to hamartomas.

Diagnosis, Differential↗
PubMed1975

Studies on pure red cell aplasia. VII. Presence of proerythroblasts and response to splenectomy: a case report.

An 18-yr-old female with chronic active hepatitis developed a severe anemia due to a lack of red cell production. Her bone marrow showed many large proerythroblasts but an almost complete lack of more mature erythroblasts. Incubation of the marrow cells in a normal medium with erythropoietin concentrate led to increased erythropoiesis as indicated by the development of mature erythroblasts as well as a ninefold increase in hemoglobin synthesis. The patient's plasma was cytotoxic for erythroblasts. Following splenectomy, a remission of the disease occurred. This study indicates that in some cases the anemia associated with abundant marrow proerythroblasts and the absence of mature erythroblasts has the same pathogenesis as pure red cell aplasia and that splenectomy may be beneficial when there is a lack of response to immunosuppressive drugs.

Adolescent↗
PubMed2001

[Laparoscopic splenectomy in the treatment of hematologic diseases].

Laparoscopic approach to surgical procedures in children is used in different diseases, but there are some controversies for using this technique in the splenectomy. Laparoscopic surgery decreased pain, postoperative ileus and the hospital stay; and improve cosmetics, the most important disadvantage is the longer operating time. Splenectomy is indicated more in immune thrombocytopenic purpura (PTI) and hereditary espherocytosis (HE). We review our experience in laparoscopic spelenectomy.

Adolescent↗
PubMed2000

[Pericardial devascularization with splenectomy for the treatment of portal hypertension].

OBJECTIVE: To review our experiences in and evaluate the efficacy of pericardial devascularization with splenectomy for the treatment of portal hypertension. METHODS: From May 1972 to October 1999, 508 patients with portal hypertension were treated with this operation. 319 of them had posthepatitic cirrhosis, and 141 late stage schistosomiasis or accompanied chronic viral hepatitis. RESULTS: The bleeding control rate was 94.1%, and the overall operative mortality rate was 4.5%. The major causes of death were upper gastrointestinal bleeding, intraabdominal hemorrhage, hepatic failure and hepatorenal syndrome. The mean follow-up time was 3.8 years. The 5-year survival rate was 94.1%, and the 10-year survival 70.7%. The 5-year recurrent bleeding rate was 6.2%. The 10-year recurrent bleeding rate was 13.3%. The rate of postoperative hepatic encephalopathy was 2.5% at 5 years, and 4.1% at 10 years. CONCLUSIONS: Pericardial devascularization with splenectomy was the first choice for the treatment of portal hypertension, especially for posthepatitic cirrhosis. The following were our experience: (1) thorough porto-azygos disconnection; (2) performing the operation in according to pericardial anatomy with correct surgical techniques; (3) selection of operative candidates and opportunity; (4) emphasizing perioperative management and preventing complications.

Adolescent↗
PubMed2001

[Accidental involution of the thymus after splenectomy (an experimental study)].

Using immunological, general clinical and luminescent histochemical methods experimental study of immunological status and bioamine-containing thymus structures was performed on third, seventh and fifteenth postsplenectomy days in 90 outbred albino male rats. Splenectomy leads to significant changes in blood immunological parameters and morphofunctional state of thymus bioamine-containing structures. Significant increase of biogenic amines content in all thymus structures, leukocyte number, complement activity neutrophilic granulocytes phagocytic activity, were registered in 3 days. Further growth of bioamine content, decrease of cortical and medullary substances diameter, significant number growth of juvenile forms of mast cells were observed in 7 days. Essential decline in erythrocyte number, hemoglobin and IgG and IgA content, leukocytosis with leukemoid reaction development were defined in blood formula. On 15th postsplenectomy day maximal biogenic amine concentration, especially histamine was reached and further reduction in cortex and medulla as well as decline of all the immunoglobulins and decrease of neutrophilic granulocytes phagocytosis were determined. Thus, splenectomy and subsequent development of accidental involution leads to secondary immunodeficiency and severe anemia.

Animals↗
PubMed2001

[Prophylaxis of venous thromboembolic complications in patients with hematological diseases after laparoscopic splenectomy].

In 8 patients, to whom laparoscopic splenectomy was performed, the measures for venous thromboembolic complications (VTHEC) prophylaxis were done. The expediency of application of low molecular weight heparin clecsan was substantiated, its advantages over non-fractionized heparin were depicted. Laparoscopic splenectomy permits to minimize the risk of the VTHEC occurrence in hematological practice.

Adolescent↗
PubMed2002

[Development of overt hemolytic anemia after splenectomy for thrombocytopenia in Evans syndrome with negative Coombs test].

A 69-year-old man was diagnosed as having idiopathic thrombocytopenic purpura (ITP) in April 2000, and treated with prednisolone (PSL) without effect. Splenectomy performed in June 2000 had only a transient and marginal influence on his platelet count. Two months later, he developed autoimmune hemolytic anemia (AIHA) without Coombs test positivity, and his diagnosis was changed to Coombs-negative Evans syndrome. Treatment with PSL led to recovery of his hemoglobin level, but not his platelet count. Although the mechanism responsible for development of AIHA after splenectomy in this patient with ITP remains unknown, close observation is required for any association with other autoimmune diseases such as SLE.

Anemia, Hemolytic↗
PubMed1975

[Changes in the physiol working capacity of rats following splenectomy and autologous transplantation of part of the spleen].

The author made splenectomy on 15 rats, but on other 15 rats after splenectomy he performed autotransplantation of 1/3 of the spleen in omentum majus. All rats induced the duration of swimming for one month after the operation. Two months later the rats with autotransplantation received the duration of swimming, but the splenectomized rats were under the initial values with 27%. These results showed that auto-transplantation of a portion of the spleen assured the working capacity of the examined animals.

Animals↗
PubMed1975

The value of sequential bone marrow biopsy and laparotomy and splenectomy in a series of 127 consecutive untreated patients with non-Hodgkin's lymphoma.

The information derived from sequential routine bone marrow biopsies and exploratory laparotomy with splenectomy in 127 consecutive untreated protocol patients with malignant lymphomata other than Hodgkin's disease is reviewed. Of the 61 patients with diffuse lymphomata, 36% changed stage after these diagnostic procedures, usually to a more advanced stage. Of the 66 patients with nodular lymphomata, 62% had a change in stage, almost all to more advanced stages, usually as a result of bone marrow biopsy. The correlation of pathological stages to clinical stages is presented for each of the Rappaport classification subgroups and for several age groups. The precise indications for exploratory laparotomy with splenectomy cannot yet be defined. These will have to await the results of current clinical trials, which may reveal to what degree an improvement in therapeutic results has been achieved as a result of a better knowledge of the extent of disease.

Adult↗
PubMed2002

[Prognostic factors for splenectomy for hematologic diseases].

The aim of this study was to identify the prognostic factors of intraoperative haemorrhage, perioperative blood transfusions and morbidity. We collected 120 splenectomies in Beau Séjour department of surgery, Charles' Nicolle Hospital, Tunis, Tunisia between 1979 and 1999. The descriptive analysis showed sex-ratio 0.82 with mean age (+/- standard deviation) 30.6 +/- 15 year. Idiopathic thrombopenic purpura was the principal disease indicating splenectomy. Morbidity was defined as occurrence of post operative peritoneal sepsis or bleeding. The mortality and morbidity rates were respectively 0.8% and 6.6%. The prognostic analysis didn't identify predictive factors of intraoperative haemorrhage, however it identified two independent predictive actors of specific morbidity: intraoperative haemorrhage (p = 0.03) and preoperative rate of haemoglobin (p = 0.0049).

Adolescent↗
PubMedDate not supplied

[Complications of splenectomy].

The present study is an analysis of complications developing after a total of 200 splenectomies carried out for various indications: primary hypersplenism (83), secondary hypersplenism following portal hypertension (72), diseases of the hemopoietic system (24), parasitic and infectious splenomegalies (13), rupture of the spleen or of splenic artery aneurisma (8). A number of 68 patients (34%) had a total of 73 complications following surgery. Of these 60 have recovered (30%) while 8 (representing 4% of the total), died. A total of 22 local or general septic complications were noted, as well as 20 complications generated by disturbances of the balance of fluids and/or of the coagulation system, 19 pleuro-pulmonary complications, 6 complications that were not specific for splenectomy, 5 pancreatic complications and 5 cases of hepatic failure.

Hemorrhage↗
PubMedDate not supplied

[Laparoscopic splenectomy--lessons learned from a series of 40 cases. The advantages of the postero-lateral approach].

Until October 2000 in our surgical department 40 patients underwent laparoscopic splenectomy. Seven patients were converted to laparotomy for completion of splenectomy. All of these occurred in the first 20 patients and were due to bleeding. There was no postoperative mortality. Postoperative complications occurred in two patients: one abdominal wall hematoma and a postoperative hernia. Indications were idiopathic thrombocytopenic purpura, hereditary spheocytosis, autoimmune hemolytic anemia and others. In the last 30 cases we used the postero-lateral approach, that results in reduced blood loss, fewer patients that needed to be converted to open surgery and shorter postoperative stay. Accessory spleens can be successfully localized and with a carefull technique the capsular fractures can be minimized reducing the risk of splenosis.

Adult↗