Accessory splenectomy for idiopathic thrombocytopenic purpura

Not all patients who undergo splenectomy for idiopathic thrombocytopenic purpura (ITP) respond to operation. This may be due to the presence of an accessory spleen. This is a report of three patients who underwent successful accessory splenectomy after relapse of their disease. Each patient initially experienced a complete response to splenectomy, but recurrence occurred months to years later. All of the patients had persistent Howell-Jolly bodies on peripheral blood smear, yet two of the patients had complete and sustained remissions of their disease after accessory splenectomy. Intraoperative localization of an accessory spleen may be exceedingly difficult in the patient who has undergone a previous operation. However, localization of accessory splenic tissue is greatly facilitated by use of a sterile isotopic detector probe intraoperatively after the injection of technetium-99m-labeled red blood cells. Given the morbidity and mortality rates of refractory ITP, patients who have a relapse after, or who fail to respond to, splenectomy should be evaluated for the presence of an accessory spleen, even if Howell-Jolly bodies are present on peripheral blood smear.