Blood changes after splenectomy in portal hypertension. The "Amna model"

Splenectomy is a frequently performed operation for patients with portal hypertension and hypersplenism in areas endemic for schistosomiasis. Reactive thrombocytosis [RT] has been described following splenectomy. Nevertheless, data are lacking on the long term changes of platelet count and other blood cells and indices after splenectomy in such patients. To determine the hematological changes following splenectomy in portal hypertension due to schistosomiasis. This is a prospective, observational, case study in which we did a series of full blood counts before and after splenectomy on two patients. The periods of study were 12 days and 5 months, respectively. Platelets [RT>500x10[9]] occurred after the 7[th] post-splenectomy day in both patients. In the longer study, RT continued from day 8 to week10. Extreme thrombocytosis [> 1000x 10[9]] occurred from day 11 to day 21 postoperatively. The count was back to normal by week 17. Reactive leukocytosis occurred immediately after ligation of the splenic artery, but returned to normal levels during the 2[nd] postoperative week. Erythrocytes, however, showed changes different from both platelets and leukocytes. There was "persistent anaemia" for about one month postoperatively. This study provides data that were lacking on the long term haematological effects of splenectomy in Sudanese patients with portal hypertension. Knowing these changes can have important implications on the management and follow up of such patients, and provide evidence needed for discussing guidelines of treatment. RT and leukocytosis occur after splenectomy whereas anaemia persists. RT can reach extreme levels and it is wise to monitor the platelets after the discharge of patients from the hospital. It may also be wise to consider the use of antiplatelet drugs postoperatively till the count normalizes. The persistent anaemia, however, seems to correct itself without giving haematinics or blood transfusion.

Splenectomy in a patient with treatment-resistant visceral leishmaniasis: a case report / A esplenectomia na leishmaniose visceral refratária ao tratamento clínico: relato de caso

Visceral leishmaniasis (VL), also known as Kala-azar, is a systemic infection caused by a protozoan (Leishmania) and, in its classic form, is a serious illness associated with malnutrition, anemia, hepatosplenomegaly, infectious processes and coagulopathies. The effect of splenectomy in patients with visceral leishmaniasis is not well defined; however, it is known that the spleen is the largest reservoir of infected cells belonging to the reticulo endothelial system. Therefore, the surgical procedure is an option for the debulking of parasites, providing a cure for refractory VL and minimizing the complications of hypersplenism.

A leishmaniose visceral (LV) ou calazar é uma infecção sistêmica causada por um protozoário (Leishmania) e na sua forma clássica é uma doença grave. Cursa com desnutrição, anemia, hepatoesplenomegalia, processos infecciosos e coagulopatias. O papel da esplenectomia em pacientes com leishmaniose visceral não é bem definido; entretanto, sabe-se que o baço é o maior reservatório de células parasitadas do sistema reticulo endotelial e o procedimento cirúrgico é, dessa forma, uma opção para debulking de parasitas, propiciando a cura da LV refratária e minimizando as complicações do hiperesplenismo.

Splenectomy only, and splenectomy with devascularisation in a rural hospital: a six years experience of a General Surgeon

Bilharzial portal hypertension is a common problem in Elgezira Scheme, Sudan, where this study was conducted. The most serious complication of this disease is bleeding from oesophageal varices, and many patients present with features of hypersplenism. Splenectomy is a known effective procedure to cure cytopenia in patients with hypersplenism but also play a role in arresting variceal bleeding when coupled with devascularization. The aim of this study is to determine the indications, outcome and complications of splenectomy only and splenectomy with devascularisation [SD] in patients with bilharzial portal hypertension in an area with limited hospital facilities. The hospital lacks equipments for sclerotherapy, has limited blood bank service, no consultant anaesthetist and no intensive care unit. The study was conducted during the period between June 1994 and June 2000 at Elmanagil hospital. This is a retrospective study and patients were followed up every 6 months for 3 years. One hundred and fifty patients underwent SD and 116 underwent splenectomy; 72% patients were males, 90% of the patients ages were between 20 - 60 years. Following splenectomy, cytopenia was corrected in all patients with hypersplenism within 3 months after operation. The recurrence rate of haematemesis was 12% in those 111 patients who could be followed up for 3 years. The commonest post operative complications were malaria [6%], chest infection [4%]. Less common complications were wound sepsis 1,5% intra - abdominal sepsis 1% and pseudopancreatic cyst 1%. Six patients died within the first 3 weeks [2.2%]. Splenectomy is an effective procedure to correct hypersplenism while SD control variceal bleeding due to bilharzial portal hypertension within 3 yrs period of follow up

Complicaciones de la esplenectomía en la operación de Sugiura-Futagawa / Splenectomy complications in the Surgiura-Futagawa procedure

Evaluar las complicaciones de esplenectomía en la operación de Sugiura-Futagawa. Antecedentes. La esplenectomía en hipertensión portal tiene mayores dificultades y probablemente se asocia a una mayor morbimortalidad. Método. Se realizó un estudio observacional, retrospectivo, transversal y descriptivo para analizar las complicaciones secundaria a esplenectomía en pacientes con hipertensión porta hemorrágica, tratada con la operación de Sugiura-Futagawa. Resultados. Se revisaron 155 expedientes de pacientes operados, con edad promedio de 42 años, 81 del sexo masculino y 74 del femenino. En 87 casos se demostró cirrosis hepática, en 39 fibrosis portal, en 23 cirrosis biliar primaria y en 6 hipertensión portal idiopática (hígado normal). Estos pacientes no recibieron inmunización preoperatoria contra neumococo; sin embargo, recibieron profilaxis antibiótica con cefalosporinas de primera y segunda generación. Se encontraron complicaciones en 16 casos (10.3 por ciento), trece de ellas atribuibles al procedimiento quirúrgico (peritonitis 3.9 por ciento, colecciones subfrénicas 1.9 por ciento, pseudoquiste pancreático 1.9 por ciento y fístula pancreática 0.6 por ciento y tres atribuibles a la ausencia de bazo (1.9 por ciento, manifestadas como choque séptico. Conclusión. La frecuencia de complicaciones relacionadas con esplenectomía en la operación de Sugiura-Futagawa es baja. El índice de infección relacionado con la ausencia de bazo es también bajo. La esplenectomía en la operación se Sugiura.Futagawa no es un factor contribuyente de consideración a la morbilidad postoperatoria

Esplenectomía parcial en esplenopatias hematológicas usando los rayos laser de CO2 / Partial splenectomy in hematologic splenopathies using CO2 laser rays

Se presentan 7 niños, que padecían de esplenopatías hematológicas necesitadas de esplenectomía, en edades comprendidas entre 15 meses y 15 años, con una media de 7,2 años. Se señala que las indicaciones de esplenectomía estuvieron dadas por: esplenomegalia gigante y marcados signos de hiperesplenismo. Dos niños presentaron enfermedad de Gaucher, 3 mostraron drepanocitemia, uno Sß talasanemia y otro, una leucemia mieloide crónica variedad infantil. Se informa que a todos se les practicó esplenectomía parcial, resecando de dos tercios a cuatro quintos del bazo , al que se le dejó solo un polo inferior, irrigado por arteria y vena polar. Un solo niño tuvo que ser reintervenido a las 2 horas de operado. A todos se les realizó gammagrafía con tecnetio 99m pre y posoperatorio. Se resume que hasta la fecha todos los niños se encuentran bien; se han normalizado las cifras de hematíes, leucocitos y plaquetas

Esplenomegalia idiopática no tropical e hiperesplenismos:informe de un caso / Non-tropical idiopathic splenomegaly with hypersplenism: report of a case

Aunque esplenomegalia e hiperesplenismo pueden se causados por una gran variedad de enfermedades, se han descrito casos en los cuales no es posible identificar la causa, entidad que ha sido descrita como esplenomegalia idiopática no tropical o Síndrome de Dacie. Esta es una enfermedad rara, caracterizada por explenomegalia masiva, hiperesplenismo y crecimiento hepático. Informamos los hallazgos en el estudio de un paciente que fue admitido en el hospital por esplenomegalia masiva. Hepatopatías, así como anormalidades hematológicas u otras enfermedades fueron descartadas, y se realizó esplenectomía. En el estudio histopatológico no pudieron demostrarse anormalidades. El paciente ha tenido una buena evolución en el postoperatorio inmediato y el diagnóstico final fue Síndrome de Dacie