spleen 2

spleen

Sickle cell disease

Autosomal recessive trait
Occurring mainly among those of African origin
The Hb A is replaced by Hb S.
Hb S crystallise when O2 tension is reduced.
So it may cause splenic infarcts ?
Clinical features depend on the vessel affected, so it may cause:
• Bone or joint pain
• Priapism
• Neurological signs
• Skin ulcers
• Abdominal pain


Diagnosis by:1. blood film
2. Hb electrophoresis
Treatment:
• Avoid hypoxia to prevent crisis
• Adequate hydration
• Partial exchange transfusion
• Splenectomy if:
a. hypersplenism develop
b. after 1 crisis

Porphyria

Hereditary error of Hb catabolism
Abdominal crisis characterized by sever colick and constipation and can be precipitated by administration of barbiturates.
Anaemia
Photosensitivity
Neurological and mental symptoms
Porphyrinuria occurs
So urine color may be orange.
Splenectomy has a little role


Felty syndrome

A triad of rheumatoid arthritis, leukopenia and splenomegally.

Splenectomy produce a transient improvement in blood picture but RA may respond well to corticosteroids in resistant patients.

Neoplasm

Caused by vinyl chloride and thorium dioxide

Haemangioma is the most common benign tumor of the spleen, it may convert into malignant angiosarcoma.

Lymphoma is the commonest neoplasm of the spleen.

Splenectomy play a role in lymphoma management
Especially if there is no obvious liver or nodal enlargement.

Myelofibrosis:

abnormal proliferation of mesenchymal element of the RES.
Occur in elderly patients more than 50 years
Pain caused by gross enlargement or by splenic infarcts.
Splenectomy is done to treat anaemia and to relieve the pain and discomfort.


• Injury to the Spleen
• Blunt injury : Acceleration – Deceleration energy.
• R.T.A., F.F.H.
• Penetrated Injury : Bullet, Stab , Fracture Lt lower ribs.
• Isolated or Combined.
• Injury Grading (Splenic CT Injury Grading Scale) .
• Splenic CT Injury Grading Scale.
• A way to remember this system is:
• Grade 1 is less than 1 cm.
• Grade 2 is about 2 cm (1-3 cm).
• Grade 3 is more than 3 cm.
• Grade 4 is more than 10 cm.
• Grade 5 is total devascularization or maceration.

• Indications for Splenectomy

• 1. Trauma (Accidental / Intraoperative).
• 2. Oncological: Part of en-block resection of stomach or pancreas
• Diagnostic.
• Therapeutic.
3. Hematological diseases: to reduce anaemia, thrombocytopenia in Spherocytosis, ITP & Hypersplenism.
4. Portal Hypertension ( Variceal surgery ).


• Preoperative Preparations
• Blood bank.
• According to the disease.( bl. tendencies).
• Coagulation profile.
• Prophylactic antibiotics.
• Preoperative Immunization.
• Surgical Modalities
• Open Splenectomy
• Emergency
• Elective
• Lap. Splenectomy

Postoperative Complications

1. Bleeding ( slipped ligature)

2. Gastric:

• Hematemesis
• Gastric dilatation
• Gastric fistula
3. pancreatic:
• Damage to tail of pancreas
• Pancreatic abcess
• Pancreatic fistula

4. pulmonary:

• Atelectasis
• Pleural effusion

5. Postoperative thrombocytosis:

The platelet may reach 1,000,000 per ml, prophylactic aspirin may be given to prevent venous thrombosis

6. Post splenectomy Septicemia, caused by:

a. strept. Pneumonia
b. N. meningitides
c. H. influenzae & E. coli.

Patient at more risk to develop septicemia are:

• Young age
• Who treated with chemotherapy
• Who have Thalassemia
• Appropriate and timely immunization
• Antibiotic prophylaxis
• Prompt treatment of infection.


Antibiotic prophylaxis:
if child had splenectomy before age of 5 years

Should be treated with daily penicillin until the age of 10.

if child had splenectomy after age of 5 years

Should be treated until age of 16

in adult patient its non useful

The greatest risk of OPSI is during the first 2-3 years, so its reasonable to give antibiotic prophylaxis during this period.

Immunization:

Pneumococcus and meningococcus C both repeated every 5 years.
H influenza type B repeated every 10 years
yearly influenza vaccination is highly recommended

Timing of immunization:

2 weeks before surgery if was ellective
As soon as possible after surgery if was emergency.


Thank you