Accessory splenectomy in management of recurrent idiopathic thrombocytopenic purpura

Residual splenic tissue can occasionally be responsible for recurrent idiopathic thrombocytopenic purpura after splenectomy. Although this is an uncommon phenomenon, we have identified six such patients at the Mayo Clinic in the last 40 years, and a review of the literature revealed nine others. Only 4 of the 15 patients with sufficient follow-up were significantly improved after splenectomy, 1 requiring less medication to control his thrombocytopenia. The presence of residual splenic material is suggested by the absence of Howell-Jolly bodies in the peripheral smear and confirmed by technetium-99m scanning. Accessory splenectomy should be considered as an adjunct to the control of idiopathic thrombocytopenic purpura in previously splenectomized patients but with the realization that remission or improvement in the clinical course may occur in only about one-half of such patients.