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Splenosis after splenectomy and spleen tissue autoimplantation: Late followup study
Carlos T Brandt1, S C S Brandão, A L C Domingues
1Department of Pediatric Surgery, Federal University of Pernambuco (UFPE), Brazil.
Insights
Splenectomy with spleen autoimplantation in children with hepatosplenic schistosomiasis resulted in efficient splenosis, preventing overwhelming postsplenectomy infection (OPSI) long-term. Nuclear medicine confirmed splenosis efficacy.
Area of Science:
- Surgical intervention and immunology
- Medical imaging and diagnostics
Background:
- Severe hepatosplenic schistosomiasis often necessitates splenectomy.
- Spleen autoimplantation aims to mitigate overwhelming postsplenectomy infection (OPSI).
- Long-term efficacy of spleen autoimplantation requires evaluation.
Purpose of the Study:
- To assess long-term splenosis after spleen autoimplantation in children with hepatosplenic schistosomiasis.
- To compare the effectiveness of hepatosplenic scintigraphy and abdominal ultrasound in evaluating splenosis.
- To determine the incidence of OPSI in patients with remaining splenosis.
Main Methods:
- Nineteen patients who underwent spleen autoimplantation in childhood were studied.
- Patients were evaluated for infection rates and OPSI after a mean follow-up of 12.1 years.
- Hepatosplenic scintigraphy with Tc-99m and abdominal ultrasound were used to assess splenosis, defined as ≥5 spleen nodules.
Main Results:
- No patients experienced an increased infection rate or developed OPSI.
- Efficient splenosis was observed in 84.2% of patients (16 out of 19).
- Hepatosplenic scintigraphy was deemed the gold standard for evaluation.
Conclusions:
- Postoperative splenosis remains efficient in most patients years after surgery.
- Spleen autoimplantation is an effective strategy for preventing OPSI in this population.
- Nuclear medicine imaging is superior for assessing splenosis post-autoimplantation.
Aim:
In children suffering from severe hepatosplenic schistosomiasis, the surgical protocol includes splenectomy and autoimplantation of spleen morsels in the major omentum, which has the potential of reducing the overwhelming postsplenectomy infection (OPSI). The purpose of the study was to evaluate the remaining splenosis, with the mean postoperative followup of 12.1 ± 5.6 years; to compare the efficacy of the 2 evaluation tools.
Materials And Methods:
Nineteen patients underwent, when they were children, portal decompression and autoimplantation of spleen. After a mean age of 23.4 ± 5.3 years, they were investigated regarding the number of infections and OPSI. They had undergone hepatosplenic scintigraphy with labeled colloidal SnTc(99m) and abdominal ultrasound. It was considered efficient splenosis when the patients presented with 5 or more spleen nodules. The evaluation was performed by 3 observers.
Results:
None of the patients had increased infection rate or developed OPSI. Sixteen (84.2%) presented efficient splenosis.
Conclusions:
The remaining postoperative splenosis was considered efficient in the majority of patients in the long-term followup; and nuclear medicine was considered the gold standard for splenosis evaluation.
