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At least 1,693 records · Page 94Linked to original sources
PubMed1997

Splenectomy and spleen autotransplantation due to splenic cyst.

Splenectomy is known to increase the risk of Overwhelming Postsplenectomy Infection (OPSI). Autotransplantation is one of the possibilities to preserve splenic functions. The authors performed spleen autotransplantations in two cases after the splenectomy of cystigerous spleens. Ten pieces from the intact spleens each sized 10 x 20 x 2 mm were implanted in between the plates of the great omentum according to Furka's spleen apron method. The function of the reimplanted splenic tissue was demonstrated by scintigraphic investigations.

Adult↗
PubMed1997

[Iatrogenic splenectomy in surgery of renal tumors].

A description of our experience with iatrogenic spleen lesions requiring splenectomy caused during surgery for a renal tumour. Out of a total 83 nephrectomies due to renal tumour performed in our Centre between 1988 and 1996, 46 were left and 4 of them (8.7%) involve splenectomy. Clinical, surgical, pathoanatomical and follow-up data of these 4 cases is analyzed. Anatomical relationship of the spleen with kidney and colon, as well as factors to consider during surgery to avoid splenic lesions are discussed.

Aged↗
PubMedDate not supplied

[Pneumocystosis of splenic localization in the course of HIV infection: a new indication for splenectomy. Description of a case].

Pneumocystis carinii is a common cause of interstitial pneumonitis in AIDS patients: it affects 85% of patients with cell-mediated immunodeficiencies. Extrapulmonary infection is much more infrequent and it is observed only in these patients who receive aerosolized pentamidine prophylaxis because of minimal systemic distribution of the drug. No case of extrapulmonary disease was observed in patients receiving systemic prophylaxis for Pneumocystis carinii with cotrimoxazole. The pathogenesis of extrapulmonary infection is not clear: it is probably connected with hematogenous or lymphatic dissemination from the lung. In a small number of case is due to reactivation of extrapulmonary foci or to a new infection. The management of disseminated infection of Pneumocystis carinii is medical: only recently a combination of medical and surgical approach was proposed for a patient with extrapulmonary infection. We report a case of 29 years old patient with AIDS with a demonstrated pulmonary and splenic localisation of pneumocystis carinii submitted to surgical splenectomy. The surgical decision was taken for several reasons: no response to medical therapy, the relative good general condition of the patient despite the immunological status, the presence of thrombocytopenia and abdominal pain in the left upper quadrant, and the risk of rupture of spleen. The post-operative course was eventful. We support splenectomy for splenic infection of Pneumocystis carinii in very small selected cases and only with palliative intent.

Adult↗
PubMed1998

[Laparoscopic splenectomy].

To date more than 400 laparoscopic splenectomies have been reported in the literature. The main indications for the procedure are benign haematological diseases, in particular idiopathic thrombocytopenic purpura. Laparoscopic splenectomy to treat malignant illnesses is rare and is usually restricted to small or only moderately enlarged spleens. Technically, the lateral abdominal approach with the patient in a right decubitus position has the advantage over the anterior approach in the supine patient of permitting better access to the organ. Under the force of gravity the stomach and intestines drop out of the operating field, and the splenic ligaments are placed under tension. This facilitates dissection with the harmonic scalpel and safe divisioning of the hilar vessels using the linear stapler. The individual steps of the procedure are described in detail.

Humans↗
PubMedDate not supplied

[Video laparoscopic splenectomy in a patient with splenomegaly due to hereditary spherocytosis: report of two cases].

We present a case report of laparoscopic splenectomy in two patients with congenital spherocytosis. A 23-year-old man and a 25-year-old woman with splenomegaly due to congenital spherocytosis underwent laparoscopic splenectomy. Their postoperative course was uncomplicated and they were discharged on the second and fourth postoperative day, respectively.

Adult↗
PubMed1997

[Splenectomies for Hodgkin's disease--a study of the period 1984-1994].

Explorative laparotomy with ensuing splenectomy in Hodgkin's disease is applied for the first time in the Stanford University in the late 60-ies. Opinions on the pros and cons of the method in terms of number of cases, complications and the like are largely dissenting. The analysis covers 153 patients with Hodgkin's disease subjected to splenectomy. Primary diagnosis is made on the ground of lymph node biopsy. Wide spreading of the disease, coincidence of diagnoses in different locations and complications are briefly discussed, with recommendations made concerning improvement of the organization of sample handling and correlation with the clinical findings.

Biopsy↗
PubMed1998

Laparoscopic versus open splenectomy in the management of splenomegaly: our preliminary experience.

BACKGROUND: Laparoscopic splenectomy for normal-sized spleens has several advantages compared with laparotomy. Only a few cases of splenomegaly done by laparoscopy are reported in the literature. The purpose of this study is to show that laparoscopy for splenomegaly is feasible and has several advantages over the open operation. METHODS: We performed retrospective chart review of 8 cases of splenomegaly managed by laparoscopy (group 1), 15 cases of open splenomegaly (group 2), and 27 cases of laparoscopic splenectomy for normal-sized spleens (group 3). Comparison has been done between groups 1 and 2 and groups 1 and 3 in terms of operative time, intraoperative estimated blood loss, need for blood transfusion, postoperative ileus, postoperative stay, and mortality and morbidity rates. RESULTS: Patients in group 1 required longer operative time and significantly less intraoperative blood transfusion compared with group 2. The postoperative course was less complicated and shorter in group 1 than in group 2. Operative time was longer in group 1 compared with group 3. No significant differences in terms of postoperative course have been found between groups 1 and 3. CONCLUSIONS: Laparoscopy for splenomegaly is a feasible, effective, and safe technique for experienced laparoscopic surgeons. This approach seems to have several advantages over the open operation. Prospective, randomized trials would be required for a proper quantitative evaluation.

Adult↗
PubMed1998

Elective splenectomy in relapsing thrombotic thrombocytopenic purpura.

Between 20 and 40% of surviving patients with thrombotic thrombocytopenic purpura (TTP) have relapses. Plasma exchange therapy is usually effective in treating relapses, but this treatment does not prevent TTP recurrence. The role of splenectomy in relapsing TTP is still controversial. We describe a patient with multiple relapses of TTP who was successfully treated with elective splenectomy.

Adult↗
PubMedDate not supplied

Laparoscopic splenectomy for an inflammatory pseudotumor of the spleen: operative technique and case report.

The case of a primary inflammatory pseudotumor of the spleen in a 44 year-old female is herein reported. This lesion is extremely rare, with only 33 cases previously reported. The splenic tumor was preoperatively diagnosed as a hemangioma by the combined modalities of ultrasonography, computed tomography and magnetic resonance imaging. A laparoscopic splenectomy was, thus, performed in order to make a final diagnosis. Pathological examination of the mass revealed an inflammatory process. Based on the above findings, a laparoscopic splenectomy is recommended when the tumor is suspected to be benign.

Adult↗
PubMed2005

Laparoscopic splenectomy for isolated sarcoidosis of the spleen.

Sarcoidosis is a granulomatous disease of unknown etiology. Over 90% of patients with sarcoidosis present with pulmonary findings at the time of diagnosis. Extrapulmonary involvement is common, including the liver, eyes, central nervous system, lymph nodes, and joints. However, isolated granulomatous disease confined to the spleen is rare. This report documents a rare case of isolated granulomatous disease of the spleen diagnosed and treated laparoscopically. A 47-year-old female presented to her internist with nausea and mild epigastric abdominal pain. Laboratory evaluation revealed slightly elevated bilirubin and liver function tests as well as neutropenia. An abdominal ultrasound revealed normal biliary and pancreatic anatomy and multiple splenic lesions. Computed tomography of the abdomen confirmed the multiple hypodense lesions within the spleen. The differential diagnosis at this time included neoplasm, infection, and autoimmune etiologies. Subsequently, the patient underwent a diagnostic laparoscopy with splenectomy. No other intra-abdominal pathology was found. Pathology revealed multiple noncaseating, splenic granulomas. Isolated extrapulmonary manifestations of sarcoidosis occur in only 10% of these patients. Moreover, isolated splenic sarcoidosis is rare. Currently, the literature documents only two prior cases of sarcoidosis presenting with isolated splenic lesions. Primary management consists of medical therapy with prednisone, methotrexate, and/or antimalarial drugs. Indications for surgery include symptomatic splenomegaly, severe hypersplenism, prophylaxis for splenic rupture, and neoplastic exclusion. Our patient required a laparoscopic splenectomy for diagnostic purposes and neoplastic exclusion. Once diagnosed, patients require continual follow-up for systemic manifestations and associated complications of sarcoidosis.

Female↗
PubMed1996

Laparoscopic distal 70% pancreatectomy and splenectomy for chronic pancreatitis.

OBJECTIVE: The authors performed an initial clinical evaluation of laparoscopic pancreatectomy with splenectomy for chronic pancreatitis. SUMMARY BACKGROUND DATA: Severe intractable pain is the most common indication for resection in chronic pancreatitis. Localized accentuation of the pathology, usually in the head of the organ, is the basis for localized proximal resection, often with preservation of a rim of pancreas and the duodenum, although some favor total pancreatectomy. The reported results for distal pancreatectomy have been variable. Distal resections are limited to those patients in whom the gross pathology is maximal in the left hemipancreas. METHODS: A consecutive series of five patients with intractable pain due to chronic pancreatitis have been treated with laparoscopic 70% distal pancreatectomy and splenectomy using a 5-port technique. RESULTS: The procedure was completed in all with an average operating time of 4.5 hours and a mean intraoperative blood loss of 400 mL. There was one minor pancreatic leak, which resolved spontaneously. The median postoperative hospital stay was 6 days. CONCLUSIONS: Laparoscopic distal pancreatectomy for chronic pancreatitis is feasible, the procedure appears to be safe, and it is accompanied by an accelerated recovery.

Adult↗
PubMedDate not supplied

Laparoscopic splenectomy for isolated parenchymal splenic metastasis of ovarian cancer.

Metastatic carcinoma of the spleen occurs in a setting of widespread malignant disease. Solitary parenchymal splenic metastasis of ovarian carcinoma is rare. We report a case of a 59-year-old woman who presented with an elevated serum CA125 level due to a solitary splenic metastasis after a long disease-free period. She was treated with laparoscopic splenectomy followed by chemotherapy. The literature contains 16 cases of solitary parenchymal splenic metastasis of ovarian carcinoma. Our case is the third case that was treated with laparoscopic splenectomy. We review the literature, and we focus on the laparoscopic approach in managing these cases.

CA-125 Antigen↗
PubMed1996

Granulomatous disease in common variable immunodeficiency: effect on immunoglobulin replacement therapy and response to steroids and splenectomy.

A 40 year old white woman with common variable immunodeficiency of four years duration presented with rapidly increasing splenomegaly. Despite high dose, weekly intravenous immunoglobulin, it was impossible to raise the trough serum IgG concentration to within the normal range. While waiting for a diagnostic splenectomy, low dose corticosteroids were started, leading to a decrease in the size of the spleen and an increase in the trough IgG concentration. Both spleen and liver showed non-caseating granulomas. Following splenectomy, the corticosteroids were tailed off and the trough IgG was maintained well into the normal range on a reduced, fortnightly dose of intravenous immunoglobulin and a low dose of oral corticosteroid.

Adult↗
PubMed1977

Nonsurgical splenectomy.

Surgical removal of the spleen is a well established procedure which is indicated for various hematologic disorders. Patients who are poor surgical risks may be considered for nonsurgical "splenectomy* using an embolization technique. This new technique should only be performed in patients who represent high surgical risk. The possible effectiveness of this procedure should be previously tested with the use of intraarterial vasopressin infusion. The following conditions should be fulfilled: (1) small emboli should be used to eliminate collateral flow; (2) the procedure should be carried out in two or three stages to minimize flank pain and the risk of massive splenic necrosis; and (3) most important, the spleen should be surgically removed as soon as the hematologic condition has improved in order to prevent splenic abscess formation. Splenic embolization was carried out in three patients with hypersplenism. One survived but was not helped by the procedure. Two died, one definitely and the other possibly as a result of the embolization. These discouraging results were reproduced in the animal laboratory where 11 of 14 animals developed severe complications, six of which were acutely fatal. The high incidence of late complications precludes non-surgical splenectomy as a routine procedure, but it can be carried out provided the spleen can be removed surgically.

Aged↗
PubMed1990

Partial splenic embolization. An effective alternative to splenectomy for hypersplenism.

Splenectomy for massive splenomegaly and hypersplenism carries a significant morbidity and mortality. We have used partial splenic embolization (PSE) as an effective alternative to splenectomy. Ten PSE procedures were performed on nine patients without mortality and with minimal morbidity. The age of the patients ranged from 8 months to 32 years (mean 14 years). The causes of splenomegaly and hypersplenism included cystic fibrosis with cirrhosis (2), tyrosinemia and cirrhosis (1); thalassemia (1), hemophilia with Human Immune Deficiency Virus infection (2), chronic hepatitis with portal hypertension (1), malignant histiocytosis (1), and Wiskott-Aldrich Syndrome (1). All procedures were performed under local anesthesia with sedation. A percutaneous femoral artery approach to the splenic artery was used to deliver Ivalon sponge particles (280-800 microns) into the spleen. Splenic infarction was assessed by postembolization angiograms. All of the patients except one demonstrated improvement of hematologic parameters. In one patient, however, cytopenia improved only after a second embolization. In the total series, there was an early mean rise of 8,600/mm3 in the leukocyte count (range 2,900-14,900) and 212,000/mm3 in the platelet count (range 30,000-718,000). Follow-up ranged from 4 months to 7 years. Improvement of the blood picture has been persistent in seven of the eight patients who showed initial improvement. Transient procedural complications included fever (5), pleural effusion (2), pneumonia (1), and splenic abscess (1). One patient had paralytic ileus lasting for 10 days and one patient developed a streptococcal peritonitis 3 weeks after embolization. No patient developed pancreatitis or vascular compromise of other abdominal viscera.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1978

Splenectomy and the thymic involution of increasing age.

Forty young female rats, aged about 3 months, were weighed on entry into the study; half were subjected to initial splenectomy. Animals were weighed at monthly intervals therafter. Ten animals from each group were killed at four months, and ten from each group at one year. Thymuses and spleens were dissected out and weighted. Because of progressive weight gain, all groups showed declining thymic index. Absolute thymus weight did not change signficiantly in splenectomized animals. Intact animals showed significantly reduced thymus weight at 4 months (P less than .001) and at 12 months (P less than .005). We conclude that the spleen may be a causative factor in the thymic involution of increasing age. The process is gradual and indolent compared to the rapid thymic weight depletion that occurs in the presence of growing tumor.

Aging↗
PubMed1981

Twenty years of splenectomy for hereditary spherocytosis.

A retrospective study of all patients who underwent splenectomy during the 20-year period, 1960 to 1979, for hereditary spherocytosis at the Johns Hopkins Hospital, Baltimore, identified 58 patients, of whom 20 (33%) were 15 years of age or older. Accessory splenic tissue was located in ten (17%) of the patients. Although cholelithiasis was present in only 12 (21%) of the total cohort, when analyzed for patients 10 years of age or older the incidence was 41% (11/27). Because of the positive association between advancing age, cholelithiasis, and hereditary spherocytosis, it is recommended that any patient 10 years of age or older undergo an oral cholecystogram as part of the routine preoperative evaluation.

Adolescent↗
PubMed1999

Splenectomy during partial remission in thrombotic thrombocytopenic purpura with prolonged plasma exchange dependency.

Some patients with thrombotic thrombocytopenic purpura (TTP) remain plasma-exchange-dependent for prolonged periods of time. This exposes patients to risk, uses substantial resources, and requires prolonged hospitalization. We have splenectomized 7 such patients following 25-42 plasma exchanges while patients were in partial remission only and were clinically stable. In 6 patients, including 1 with TTP secondary to mitomycin C, thrombocytopenia promptly resolved. Relapse has not occurred during 18 or more months of observation. The seventh patient did not respond. We conclude that splenectomy should be considered as an alternative to continued plasma-exchange therapy in such patients.

Adrenal Cortex Hormones↗