Splenectomy

Source: Wikipedia, the free encyclopedia.
Splenectomy
Surgically removed spleen of a child with thalassemia. It is about 15 times larger than normal.
ICD-9-CM41.43, 41.5
MeSHD013156
OPS-301 code5-413

A splenectomy is the surgical procedure that partially or completely removes the spleen. The spleen is an important organ in regard to immunological function due to its ability to efficiently destroy encapsulated bacteria. Therefore, removal of the spleen runs the risk of overwhelming post-splenectomy infection, a medical emergency and rapidly fatal disease caused by the inability of the body's immune system to properly fight infection following splenectomy or asplenia.[1]

Common indications for splenectomy include trauma, tumors, splenomegaly or for hematological disease such as sickle cell anemia or thalassemia.[2]

Indications

The spleen is an organ located in the

secondary lymphoid organ in the body.[3] Apart from regular lymphatic function the white pulp contains splenic macrophages which are particularly good at destroying (phagocytosis) encapsulated bacteria such as Streptococcus pneumoniae.[4] The spleen is also known to function as a site for the development of new red blood cells from their hematopoietic stem cell precursors, and particularly in situations in which the bone marrow, the normal site for this process, has been compromised by a disorder such as leukemia. The spleen is enlarged in a variety of conditions such as malaria, mononucleosis and most commonly in cancers of the lymphatics, such as lymphomas or leukemia
.

It is removed under the following circumstances:

  1. When it becomes very large such that it becomes destructive to platelets/red blood cells or rupture is imminent
  2. For diagnosing certain lymphomas
  3. Certain cases of splenic abscess
  4. Certain cases of wandering spleen
  5. Splenic vein thrombosis with bleeding Gastric varices
  6. When platelets are destroyed in the spleen as a result of an
    idiopathic thrombocytopenic purpura
    .
  7. When the spleen bleeds following
    physical trauma
  8. Following spontaneous
    rupture
  9. For long-term treatment of congenital erythropoietic porphyria (CEP) if severe hemolytic anemia develops[5]
  10. The spread of gastric cancer to splenic tissue
  11. When using the splenic artery for kidney revascularisation in renovascular hypertension.
  12. For long-term treatment of congenital pyruvate kinase (PK) deficiency
  13. Those who have a severe version of the hereditary blood disorder Spherocytosis.
  14. During surgical resection of a pancreatic cancer

The classical cause of traumatic damage to the spleen is a blow to the abdomen during a sporting event. In cases where the spleen is enlarged due to illness (mononucleosis), trivial activities, such as leaning over a counter or straining while defecating, can cause a rupture.

Procedure

splenorenal ligament and splenocolic ligament, are dissected and the organ is removed. In some cases, one or more accessory spleens are discovered and also removed during surgery. The incisions are closed and when indicated, a drain is left. If necessary, tissue samples are sent to a laboratory for analysis.[citation needed
]

Side effects

Splenectomy causes an increased risk of

opsonized, the infection becomes more severe.[citation needed
]

Splenectomy also increases the severity of babesiosis, Splenectomized patients are more susceptible to contracting babesiosis and can die within five to eight days of symptom onset.[7] They have severe hemolytic anemia, and occasional hepatomegaly has been documented. Parasitemia levels can reach up to 85% in patients without spleens, compared to 1–10% in individuals with spleens and effective immune systems.[8]

An increase in blood

Glucose-6-Phosphate Dehydrogenase) and chronic liver disease.[14]

A splenectomy also results in a greatly diminished frequency of memory B cells.

ischemic heart disease (41 deaths rather than the expected 30.26) but not from other conditions.[16]

Subtotal splenectomy

Much of the spleen's protective roles can be maintained if a small amount of spleen can be left behind.[17] Where clinically appropriate, attempts are now often made to perform either surgical subtotal (partial) splenectomy,[18] or partial splenic embolization.[19] In particular, whilst vaccination and antibiotics provide good protection against the risks of asplenia, this is not always available in poorer countries.[20] However, as it may take some time for the preserved splenic tissue to provide the full protection, it has been advised that preoperative vaccination still be given.[21]

See also

References

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  4. ^
    S2CID 30554953
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  5. ^ Frye R. (2006-03-02). "Porphyria, Cutaneous". eMedicine. Retrieved 2006-03-28.
  6. ^
    PMID 23801854
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  7. ^ "Babesiosis". National Institute of Allergy and Infectious Diseases, National Institutes of Health. 2009-02-19. Archived from the original on 2009-03-05.
  8. ISBN 978-0071466332
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  9. PMID 8601117
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  10. ^ Kolata G (9 November 2004). "A Diabetes Researcher Forges Her Own Path to a Cure". The New York Times.
  11. Who Named It?
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  13. ^ Rodak B, Fritsma G, Doig K. Hematology: Clinical Principles and Applications.
  14. PMID 11681780
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  15. PMID 12682112
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  16. S2CID 38605411
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  17. PMID 957066
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  18. S2CID 22741973
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  19. S2CID 41343243
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  20. PMID 18031639
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  21. PMID 9660206
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