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
Brigden M L, Pattullo A L.
Prevention and management of overwhelming post-splenectomy infection - An update.
Crit Care Med 1999; 27:
836-842.
Working Party of the British Committee for Standards in Haematology Clinical haematology Task Force.
Guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen. Br
Med J 1996; 312: 430-4. |