Indications of splenectomy

  • Splenic trauma- most common indication, hemodynamic instability
  • Purpuras: Idiopathic thrombocytopenic purpura (ITP)
  • Haemolytic anaemias: Hereditary spherocytosis, Acq. haemolytic anaemia.
  • Hypersplenism
  • Left sided portal hypertension
  • Myelofibrosis
  • Tumours: Lymphomas, haemangioma
  • Cyst of spleen
  • Splenic infarct
  • Abscess
  • Splenic artery aneurysm

Uncommon indications of Splenectomy

  • Cysts:
    • Congenital, degenerative, hydatid disease.
    • Infarction spleen: arterial embolism,
    • Asymptomatic/ pain LUQ.
    • CT: hypo-perfused area
  • Splenic abscess
  • Splenic artery aneurysm:
    • Typically incidental finding, female, rupture during pregnancy.
    • Treatment: proximal location – proximal & distal ligation. Distal location- proximal ligation with splenectomy
  • Part of other surgery : Distal pancreatectomy, radical gastrectomy for ca.

Complications of Splenectomy

  • Early:

    • Haemorrhage (2-5%)
    • Organ injury- pancreas (0-6%-open, up to 16%- laparoscopic), splenic flexure, stomach
  • Delayed:

    • Fistula- stomach, pancreas
    • Sub-diaphragmatic collection
    • Left basal atelectasis & pleural effusion
    • Thrombocytosis- thrombotic complications
    • OPSI- H influenzae, Meningococcus
    • Splenosis- splenic rupture, bag rupture in laparoscopic surg.

Effects of Splenectomy

  • RBC: Howell Jolly bodies, erythroblasts
  • WBC: Leucocytosis
  • Platelet: Thrombocytosis, increased adhesiveness. - aspirin; 1 million
  • Immunological defects:
    • ↓ serum IgM level
    • ↓ level of phagocyte promoting peptide
    • ↓ response to particulate antigens

Immunization

  • Prone to infection (encapsulated bacteria- Strep pneumoniae, Neisseria meningitides, Haemophilus influenzae)

  • Elective splenectomy: vaccination 2-3 weeks before surgery

  • Emergency splenectomy- vaccination postoperatively - Polyvalent pneumococcal vaccine (pneumovax)

  • Not previous immunized persons:

    • Strep pneumoniae (booster dose in 8 weeks)
    • Haemophilus influenza type b (Hib)
    • Meningococcal type c
  • Life long antibiotic prophylaxis:

    • Oral phenoxymethyl penicillin or erythromycin