Splenic flexure volvulus presenting with gangrene.

Volvulus of the splenic flexure is very rare cause of colonic obstruction constituting 2% of cases of colonic segmental volvulus. Primary splenic flexure volvulus (SFV) is due to congenital absence or laxity of the phrenocolic, gastro colic, and splenocolic ligaments while secondary volvulus is due to other causes including some prior surgery releasing these ligaments. A preoperative diagnosis can be established based on the characteristic radiological findings on plain x-ray abdomen and CT scan. We present a case of SFV in a young man who presented with acute abdominal pain, and distension, and illustrate the usefulness of CT scan, and plain x-ray of the abdomen in making a preoperative diagnosis. Laparotomy revealed a gangrenous SFV, which was resected and primary anastomosis was carried out. Literature is reviewed with regards to predisposing factors, presentation, investigation, and management among the more than 32 cases reported so far.

Radioterapia esplénica: a propósito de 8 casos. Indicaciones y revisión de la literatura / Splenic irradiation: a proposal of 8 cases. Clinical indications and literature review

Las indicaciones de la radioterapia (RT) esplénica en los desórdenes hematológicos incluye la irradiación del bazo en aquellos procesos linfoproliferativos, que cursan con infiltración del mismo, el tratamiento paliativo de la esplenomegalia en las enfermedades malignas como la leucemia linfoide crónica o los síndromes mieloproliferativos, que cursan con dolor por la distensión capsular del bazo, y las citopenias secundarias al hiperesplenismo. En este trabajo presentamos la experiencia acumulada en el tratamiento de la esplenomegalia con RT del Hospital General Universitario Gregorio Marañón en los últimos 5 años, analizando sus indicaciones, resultados y toxicidad así como una revisión actualizada de la literatura

Clinical indications of splenic irradiation in haematological disorders include the irradiation in lymphoproliferative disorders with spleen infiltration, palliative treatment of splenomegaly in malignant diseases like chronic lymphocytic leukaemia or myeloproliferative disorders, with the purpose of relief from abdominal pain associated with capsular enlargement size and decrease cytopenias secundaries to hypersplenism. This paper reports our experience with spleen irradiation in the Hospital General Universitario Gregorio Marañón in the last five years, and analizes indications, results and toxicity, and an actual review of the literature

An audit of the indications for and techniques of palliative splenic radiotherapy in the UK.

AIMS: This paper describes a national audit of the indications for, and techniques and toxicity of, palliative splenic radiotherapy in haematological disorders. MATERIALS AND METHODS: A postal questionnaire was sent to consultant clinical oncologists treating haematological malignancies in the UK. RESULTS: The response rate was 76%. The audit shows chronic lymphocytic leukaemia, myelofibrosis and chronic myeloid leukaemia to be the most common underlying conditions in which splenic irradiation is used. Painful splenomegaly and hypersplenism were the most common indications. Dose fractionation schedules vary widely across the UK, and also the level of full blood counts used to interrupt radiotherapy. CONCLUSIONS: Palliative splenic radiotherapy continues to be widely used in the UK in small numbers of patients and seems to be well tolerated. Re-irradiation for further symptomatic progression is also commonly carried out.

Evaluation of splenectomy in chronic myelogenous leukemia.

Splenectomy was performed in 45 patients with chronic myelogenous leukemia; 23 were in the chronic phase and 22 in the acute phase. Indications for operation included inability to control the disease by chemotherapy or radiation therapy, severe thrombocytopenia, frequent need for blood transfusion and extensive splenomegaly causing discomfort. Median survival time for these patients was better than survival time of other reported groups of patients who did not have a splenectomy. According to our criteria, splenectomy was beneficial to 15 patients in the chronic phase as well as to eight in the acute phase of chronic myelogenous leukemia. Median survival time after splenectomy was higher in patients who had splenectomy within two years of the diagnosis as compared with those who had the operation after two years. Splenectomy did not prevent the future onset of fatal blastic crisis. Although significant abnormalities in coagulation studies were seen in 37 of the patients, intraoperative hemorrhage was not a major problem. Considering the poor general condition, inadequate healing and susceptibility to infection, the postoperative mortality and complication rates were comparable with those reported in series in which splenectomy was performed for other diseases. It seems that splenectomy benefits a selected group of patients with chronic myelogenous leukemia; however, a randomized series would furnish better data upon which to make decisions.