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Splenectomy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Marcus D. Jarboe, Steven W. Bruch
A splenectomy requires separation of the spleen from its blood supply, and from its ligamentous attachments. The splenic artery and vein provide the majority of the blood supply with the short gastric vessels supplying a portion to the upper pole (Figure 57.1). The splenic artery and vein divide prior to entering the splenic hilum, allowing division of the main pedicles or the individual branches entering the splenic capsule. Several methods exist to control these vessels including ligatures, stapling devices, and thermal energy devices (LigaSure [Valleylab, Boulder, CO, USA], Harmonic scalpel [Ethicon Inc., Cincinnati, OH, USA]). The proximity of the tail of the pancreas to the splenic hilum dictates meticulous dissection of the vessels to avoid injury to the pancreatic parenchyma. Ligaments attach the spleen to the lateral abdominal wall, colon, kidney, stomach, and diaphragm (Figure 57.2). These require division to expose the spleen in open operations but are mostly left intact until the end of laparoscopic operations to suspend the spleen to gain adequate exposure for vascular division.
Emergency Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Alastair Brookes, Yiu-Che Chan, Rebecca Fish, Fung Joon Foo, Aisling Hogan, Thomas Konig, Aoife Lowery, Chelliah R Selvasekar, Choon Sheong Seow, Vishal G Shelat, Paul Sutton, Colin Walsh, John Wang, Ting Hway Wong
What is OPSI?This is flu-like prodromal illness followed by headache, fever, malaise, coma, adrenal haemorrhage and circulatory collapse.It affects 2% of trauma splenectomies (risk is greatest if performed during infancy).It occurs usually within 2 years of operation, with the incidence decreasing over time after splenectomy, although delayed OPSI more than 20 years post-splenectomy have been documented.Mortality rate is high: 50%–90%.It is due to encapsulated bacteria: Pneumococcus (50%)MeningococcusEscherichia coliHaemophilus influenzae
Overwhelming Post-Splenectomy Infections in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
It is estimated that 25,000 patients undergo surgical splenectomy annually in the United States [1]. Absolute indications for surgical splenectomy include trauma (splenic rupture), splenic cysts and abscesses, and tumor resection, while relative indications include hypersplenism and symptomatic splenomegaly from conditions such as hemolytic anemia, hereditary spherocytosis, and immune thrombocytopenic purpura [9]. In recent decades, partial splenic salvage has the decreased the need for total splenectomy in certain situations such as trauma. However, surgery alone does not account for the estimated 1 million anatomic or functional asplenics in the United States [1], with the addition of congenital asplenia and the many conditions that cause hyposplenism (Table 25.1).
Splenectomy in zebrafish: a new model for immune thrombocytopenia
Published in Platelets, 2022
Uvaraj P Radhakrishnan, Ayah Al Qaryoute, Revathi Raman, Pudur Jagadeeswaran
The spleen has been once thought that it is dispensable. However, the spleen has a dual function, one is an immunological function, and the other the filtration of blood. These two essential functions are carried out by two sections of the spleen called white pulp and red pulp, respectively. Despite this functional role, splenectomy is performed to treat hemolytic anemias, sickle cell disease, and many other hematological disorders, including immune thrombocytopenia when all other medical options are not successful [1–3]. Due to the filtration and sequestration of blood cells by the spleen, splenectomy prevents that sequestration, and thus, the red cells and platelets will rise in circulation, relieving the symptoms [4,5]. Following splenectomy, there are many complications, such as infection and sepsis [6]. It has been shown that cell-derived microparticles were elevated, which resulted in an increased risk of thrombosis and other cardiovascular complications [7]. Vascular complications following splenectomy in hematologic disorders such as arteriothrombosis, deep vein thrombosis, pulmonary embolism, and pulmonary arterial hypertension, have been reported [8]. However, information on post-splenectomy vascular complications in animal models is limited [9]. In a rabbit model, pulmonary platelet thromboemboli were seen after ligation of the splenic artery [10]. Splenectomy also resulted in increased platelet counts in murine immune thrombocytopenia [11]. Unfortunately, the post-splenectomy complications in animal models are poorly studied [12].
Two-step complete splenic artery embolization for the management of symptomatic sinistral portal hypertension
Published in Scandinavian Journal of Gastroenterology, 2022
Jiacheng Liu, Jie Meng, Ming Yang, Chen Zhou, Chongtu Yang, Songjiang Huang, Qin Shi, Yingliang Wang, Tongqiang Li, Yang Chen, Bin Xiong
To avoid the occurrence of upper GI rebleeding, proper approaches should be selected to reduce portal vein system pressure. The venous pressure mainly increases on the left side of portal circulation in patients with SPH. Therefore, transjugular intrahepatic portosystemic shunt does not work, for the treatment should be directed at the left side [25]. At present, the preferred treatment is splenectomy, for spleen removal could reduce the venous inflow to the collateral circulation, and may decrease varicose vein pressure to prevent further bleeding episodes [26]. However, splenectomy would cause surgical trauma and severe complications such as infection and uncontrollable increase of platelets. A study by Qi X et al. reported that splenectomy may increase by at least 10-fold the risk of portal venous system thrombosis. In addition, pancreatitis or pancreatic tumors may induce inflammation and cell adhesion, which would make it more difficult to perform splenectomy [27,28].
Splenectomy and risk of COVID-19 infection, hospitalisation, and death
Published in Infectious Diseases, 2021
Anders Bo Bojesen, Andrea Lund, Frank Viborg Mortensen, Jakob Kirkegård
Splenectomy is a common surgical procedure, often performed due to abdominal trauma or due to hematological disorders as well as splenomegaly [7]. As part of the reticulo-endothelial system and owing to its antibody production, the spleen serves important immunological and hematological functions [8]. The spleen is crucial for both the innate and adaptive immune response and it plays an important role in removing damaged blood cells from the circulation [9]. Splenectomized patients are therefore considered to be somewhat immunocompromised and have shown to be more affected by certain bacterial infections than patients with a preserved splenic function [10]. However, the risk of viral infections in splenectomized patients is less clear. Particularly, it is unknown if splenectomized patients are more susceptible to infection with COVID-19.