Splenectomy is indicated for NHL patients with massive splenomegaly leading to abdominal pain, early satiety, and fullness. It may also be indicated for patients who develop anemia, neutropenia, and thrombocytopenia associated with hypersplenism. Splenectomy may also be instrumental in the diagnosis and staging of patients with isolated splenic disease.
Pseudocyst of the spleen are 4 times more common than the true cysts. Pseudocyst spleen is mostly acquired after trauma.
True cysts of the spleen are lined by a layer of epithelium. True cysts like columnar lined cyst of spleen are rare. The epithelial cells are rich in CEA (Carcino embryonic Antigen) and CA19- 9 but they are benign. Management is required if the cyst is more than 8 cm or causing symptoms.
Classification of Splenic cysts
True Cyst- Congenital, epidermoid, or epithelial cysts. Or Parasitic and non parasitic
Splenic cysts are most common in the 2nd and 3rd decade of life, although they have been noted in all age groups, including infants. An asymptomatic painless abdominal mass is the presenting feature in approximately 30% to 45% of cases.
Treatment options include
Pseudocyst- Aspirations, Catheter drainage, Partial splenectomy, Splenectomy or a recent technique of partial splenic decapsulization (marsupilization)
Indication of splenectomy (removal of spleen) in ITP are
1.ITP has been diagnosed for 6 weeks, still platelet count is less than 10000 with or without bleeding.
2. ITP diagnosed for 3 months with platelet count of less than 30000
Abscess of spleen result from haematogenous spread from foci such as endocarditis, osteomyelitis and IV drug abuse. It also results from spread from surrounding structures like colon and kidneys.
Both gram positive and gram negative organisms are responsible.
Splenomegaly is present in only a minority of patients. In adults 2/3rd of splenic abscess are solitary where as in children only 1/3rd are solitary.
Argon beam coagulator and other superficial coagulation devices are generallt preferred to the conventional techniques but studies have not shown a definite superiority.
In grade II and III injuries pledget suturing is advised .
Grade IV injuries are mangaed with polygalactin mesh.
Advantage of splenorrhaphy over splenectomy are
1. Immunological competence
2. Prevention of Left Subphrenic abscess.
One consistent observation is that the risk for OPSI is greater after splenectomy for malignancy or hematologic disease than for trauma
S. pneumoniae is the most frequently involved organism in OPSI and is estimated to be responsible for between 50% and 90% of cases. Other organisms involved in OPSI include Haemophilus influenzae, Neisseria meningitidis, Streptococcus species and other pneumococcal species, Salmonella species, and Capnocytophaga canimorsus
A “wandering spleen” occurs when the spleen is attached only by a long, loose vascular pedicle without the usual peritoneal attachments. Wandering spleen in children arise from congenital atresia of the dorsal mesogastrium. When found in women between 20 and 40 years of age, wandering spleens result from an acquired tissue laxity associated with pregnancy.
The condition is complicated by acute torsion around the vascular pedicle, which manifests with acute abdominal pain, fever, vomiting, acute pancreatitis, and gastric compression. Without detorsion, splenic infarction and gangrene ensue. Chronic torsion typically causes venous congestion and splenomegaly. In children without splenic infarction, the procedure of choice is splenopexy, suturing the spleen to the diaphragm, abdominal wall, or omentum.
Splenectomy is preferred in adults