Massive splenomegaly

A 16 year review of 391 splenectomies performed at New England Medical Center was done to evaluate the morbidity and mortality of patients with drained splenic weights greater than 1,000 grams. Thirty-six met the criteria for study. Twenty men and 16 women with an average age of 55.4 years were identified. Myeloproliferative disorders were the most predominant cause of massive splenomegaly. Pancytopenia and hemolytic complications of the disease processes were the most acute indications for operations. The average time between diagnosis and operative intervention was 42 months. An average of 10 units of blood products were required to correct preoperative coagulopathy. Eleven of 36 patients had postoperative complications. Eight of 21 with drains and an equal number of patients with preliminary splenic arterial ligation had complications. Eight-one per cent of all complications were infection related. Complication increased the length of stay 11 days. The 30 day mortality rate was 11.1 per cent. Sepsis was the major cause of mortality. Closed drainage system provided no demonstrable benefit nor appeared to be the cause of sepsis. No episodes of pulmonary embolic phenomenon or peripheral venous thrombosis were demonstrated. Elective splenectomy in patients with smaller spleens was performed without operative mortality and with 3 per cent morbidity rate. For patients with massive splenomegaly, the average survival time was 28.5 months. The majority of these patients died from complications of the disease. Preoperative coagulopathy, failure to demonstrate a hematologic response to splenectomy and reoperation were clear predictors for decreased long term survival periods.(ABSTRACT TRUNCATED AT 250 WORDS)