Causes of splenomegaly
- Massive
- Chronic myeloid leukaemia
- Myelofibrosis
- Moderate
- Portal hypertension
- Lymphoma
- Leukaemia
- Thalassaemia
- Glycogen storage diseases
- Small
- Polycythaemia rubra vera
- Haemolytic anaemias
- Infections - infectious mononucleosis, malaria
- Connective tissue disorders
- Infiltrations - amyloid, sarcoid
Indications for splenectomy
- Trauma
- Commonest organ injured in blunt abdominal trauma
- Associated with lower rib fractures
- 25% injuries are iatrogenic
- Delayed rupture of splenic haematoma uncommon
- Spontaneous rupture
- Usually seen in those with massive splenomegaly (e.g. infectious mononucleosis)
- Often precipitated by minor trauma
- Hypersplenism
- Hereditary spherocytosis or elliptocytosis
- Idiopathic thrombocytopenic purpura
- Neoplasia
- Lymphoma or leukaemic infiltration
- Splenectomy not usually required for diagnosis
- Only required if hypersplenism resistant to treatment
- With other viscera
- Total gastrectomy
- Distal pancreatectomy
- Other indications
- Splenic Cysts
- Hydatid Cysts
- Splenic abscesses
Overwhelming Post Splenectomy Infection (OPSI)
- Infection due to encapsulated bacteria
- 50% due to strep. Pneumoniae
- Other organisms include:
- Haemophilus influenzae
- Neisseria meningitidis
- Occurs post splenectomy in 4% patients without prophylaxis
- Mortality of OPSI is approximately 50%
- Greatest risk in first 2 years post op
Prevention of OPSI
- Antibiotic prophylaxis
- Penicillin or amoxycillin
- ? Duration ? Life long
- Prophylaxis is certainly required in children up to 16 years
- Immunisation
- Pneumococcal and Haemophilus
- Perform 2 weeks prior to planned operation
- Immediately post op for emergency cases
- Repeat every 5 - 10 years
Bibliography
Aseervatham R, Muller M. Blunt trauma to the spleen. Aust NZ J Surg 2000;
70: 333-337.
Di Sabatino A, Carsetti R, Corraza G R. Post-spelenctomy
and hyposplenic states. Lancet 2011: 378:
86-97.
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