Surgical management of giant splenomegaly in chronic myeloid leukemia: a challenging splenectomy case

Giant splenomegaly is an uncommon but significant complication of chronic myeloid leukemia (CML), often causing substantial morbidity. While tyrosine kinase inhibitors have revolutionized CML treatment, splenectomy remains necessary in selected cases, particularly when there is symptomatic hypersplenism, compressive symptoms, or risk of splenic rupture. This case describes a 35-year-old male with chronic-phase CML who presented with progressive abdominal distension, early satiety, and anemia due to massive splenomegaly. Abdominal ultrasound revealed a spleen measuring 40 cm, extending into the pelvis. Despite optimized therapy, symptoms persisted. After multidisciplinary assessment and preoperative vaccination, the patient underwent an open splenectomy. The procedure, though technically challenging, was completed without complications. Histopathology confirmed leukemic infiltration of the spleen. The patient's postoperative course was uneventful, with no adverse events. This case underscores splenectomy as a viable and effective therapeutic option in selected CML patients with symptomatic giant splenomegaly.