Splenectomy

indications

• trauma

  1. HDUS 2/2 spleen injury

  2. not a candidate for NOM

  3. failed NOM

• hematologic disorders

  1. RBC disorders

     • AIHA refractory to steroids

     • HS at 4-6 y/o w/lap cholecystectomy

     • SCD c/b sequestration crisis or abscesses

     • thalassemia w/↑transfusions or painful SM/infarct

     • PK deficiency

  2. WBC disorders

     • CLL c/b Hgb < 10 or plt < 50 or w symptomatic SM

     • hairy cell leukemia c/b sx pancytopenia or SM

     • NHL c/b SM and pancytopenia

     • HL c/b splenic involvement

  3. platelet disorders

     • ITP adults medically refractory

     • TTP w/multiple relapses or excessive TPE

• myeloproliferative disorders

  1. CML c/b symptomatic SM or refractory anemia

  2. PV medically refractory or c/b symptomatic SM

• splenic abscess/cyst

• Felty syndrome

  1. seropositive rheumatoid arthritis

  2. neutropenia

  3. SM

• splenic artery aneurysm

  1. sx SM

  2. pregnant or FORA

  3. > 2 cm

  4. located in distal segment

• splenic vein thrombosis

complications

• gastric perforation

  1. short gastric artery ligation → necrosis of stomach wall

  2. esp. problematic in emergent splenectomy

• overwhelming post-splenectomy infection (OPSI)

  1. pathogenesis

     • ↓clearance of encapsulated pathogens

     • ↓Ig production

     • sepsis develops in 0.5-2.0% asplenic patients

  2. clinical

     • months-to-years post-splenectomy

     • initial flu-like sx

• hemorrhage

  1. most commonly short gastrics or splenic artery

• abscess

• pancreas injury