Diagnostic Splenectomy: Characteristics, Pre-Operative Investigations, and Identified Pathologies for 20 Patients.

Area of Science:

• Hematology
• Oncology
• Diagnostic Surgery

Background:

• Splenectomy is typically indicated for trauma or hematological/immunological diseases.
• It is less frequently employed for diagnostic purposes when etiological investigations are inconclusive.
• Splenectomy is a high-risk procedure, considered a last resort for diagnosis and treatment.

Purpose of the Study:

• To evaluate the utility and outcomes of diagnostic splenectomies.
• To identify the primary indications and final diagnoses following splenectomy.
• To assess the effectiveness of pre-operative diagnostic tools.

Main Methods:

• Retrospective analysis of 142 splenectomy cases over 10 years.
• Identification and review of 20 cases where splenectomy was performed for diagnostic reasons.
• Analysis of pre-operative procedures, including 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) and immuno-hematological examinations.

Main Results:

• Diagnostic splenectomy contributed to the final diagnosis in 19 out of 20 cases.
• Lymphoid hemopathies were the most common diagnoses (14/20), with diffuse large B-cell lymphoma being the most frequent (8/20).
• FDG PET/CT and immuno-hematological tests were the most helpful pre-operative diagnostic tools.

Conclusions:

• Diagnostic splenectomy remains a necessary procedure for challenging cases of unexplained splenomegaly or fever of unknown origin.
• It plays a critical role in diagnosing hematological malignancies, especially lymphomas.
• Advanced imaging like FDG PET/CT significantly aids in pre-operative diagnosis.