Partial splenectomy in bilharzial hepatosplenomegaly

ABSTRACT

In Bilharzial splenomegaly splenectomy is indicated in huge spleen, in hypersplenism or in combination with devascularisation. The vital importance of both the immunological and haematological functions of the spleen necessitates preservation of this organ. Partial splenectomy was performed in 11 cases leaving a functional segment [about 25% of the enlarged spleen]. The operative technique depends on the segmental vasculature of the spleen so devascularisation of anatomic segments facilitates excision, haemostasis to the main bleeders, approximation of the capsule and row of haemostatic stitches was enough to control bleeding. The procedure was feasible, effective in relieving abdominal discomfort. Follow up ranged from 3 to 9 months with a mean of 5 months. There was improvement in the haematological profile of these cases. The residual spleen showed normal uptake of 99T C sulpher colloid. The immunological functions of the residual parts were not assessed and need further study, also the long term follow up of these cases will judge the efficacy of this procedure as an alternative to total splenectomy