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[Primary hypersplenism due by accessory spleens after splenectomy]
St O Georgescu1, L Dubei, C Cârdeiu
1Clinica I Chirurgie, Spitalul de Urgenţă Sf. Spiridon Iaşi, Universitatea de Medicină şi Farmacie Gr.T. Popa Iaşi. sgeorge@iasi.mednet.ro
Chirurgia (Bucharest, Romania : 1990)
|May 7, 2008
Summary
Primary hypersplenism can cause severe blood count issues, sometimes requiring splenectomy. This case highlights accessory spleens as a cause of recurrence, with their removal achieving high recovery rates.
Area of Science:
- Hematology
- Surgical Pathology
- Immunology
Background:
- Primary hypersplenism can manifest with cytopenias affecting red blood cells, white blood cells, or platelets.
- Splenectomy is a therapeutic option for severe hypersplenism.
- Accessory spleens can lead to treatment failure or recurrence after splenectomy.
Observation:
- A 50-year-old patient presented with purpuric phenomena 32 years post-splenectomy for autoimmune hemolytic anemia.
- Severe thrombocytopenia (2,500/mm3) was diagnosed 29 years after the initial splenectomy.
- Imaging revealed the presence of accessory spleens.
Findings:
- Ablation of accessory spleens was performed.
- Accessory spleen removal resulted in a 98-99% recovery rate.
- Failure to remove accessory spleens carries a recurrence risk.
Implications:
- Complete surgical management of hypersplenism necessitates the identification and removal of all accessory spleens.
- This approach significantly improves patient outcomes and reduces recurrence.
- Early detection and management of accessory spleens are crucial for long-term remission.
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