Applying enhanced recovery after surgery protocols in a patient with a giant spleen: a case report

Although splenomegaly is a common finding in several diseases, massive splenomegaly is rare. Patients with massive splenomegaly often present with a complex clinical picture. This case report describes a 72-year-old female with a complex medical history. Fifteen years ago, she was diagnosed with primary myelofibrosis, which subsequently led to progressive abdominal enlargement and bloating over the past 5 years. Recently, she developed edema in her limbs, accompanied by dizziness, shortness of breath, and fatigue. A massive splenomegaly was discovered during her hospitalization. Additionally, the patient has a history of Crohn's disease, gout, renal insufficiency, and hypertension. Laboratory results reveal severe anemia and thrombocytopenia. Abdominal CT scans confirm the enlarged spleen and show ascites. She was treated by a multidisciplinary team comprising several departments. Even after a period of comprehensive treatment, the symptoms of massive splenomegaly did not significantly improve. Thus, the patient underwent an open surgical excision of the giant spleen. The weight of the giant spleen was 5.0 kg. During the perioperative period, Enhanced Recovery After Surgery (ERAS) protocols were applied to facilitate recovery. Her recovery was uneventful, and she was able to resume her regular daily routine shortly after the procedure. This report presented a complex and rare case of massive splenomegaly, and underscored that a proper medical and nursing care is the key to better recovery.