Splenectomy in patients with undiagnosed splenomegaly

Area of Science:

• Medical Diagnostics
• Surgical Pathology
• Hematology

Background:

• Splenectomy, the surgical removal of the spleen, is sometimes performed for diagnostic purposes when other methods are inconclusive.
• Enlarged spleens (splenomegaly) can be associated with various hematological and oncological conditions.
• Understanding the diagnostic yield and outcomes of splenectomy is crucial for patient management.

Purpose of the Study:

• To evaluate the diagnostic utility of splenectomy.
• To determine the primary diagnoses established through splenectomy.
• To assess the correlation between spleen weight and specific diagnoses, particularly lymphoma.

Main Methods:

• Retrospective review of splenectomies performed at Cork Regional Hospital over an 11-year period.
• Analysis of indications for surgery, focusing on diagnostic splenectomies.
• Histopathological examination of excised spleen tissue for definitive diagnosis.
• Correlation of spleen weight with final diagnoses.

Main Results:

• Ten splenectomies were performed primarily for diagnostic reasons.
• A definitive histological diagnosis was achieved in nine patients.
• Lymphoma was diagnosed in seven patients (two Hodgkin's disease, five non-Hodgkin's lymphoma).
• Spleens from lymphoma patients consistently weighed over 1 kg, while those with other diagnoses weighed less than 1 kg.
• Most patients experienced symptomatic improvement, including reversal of hypersplenism and relief from pressure effects of splenomegaly.
• Operative mortality was zero.

Conclusions:

• Diagnostic splenectomy is a worthwhile procedure, particularly for establishing a diagnosis of lymphoma.
• Spleen weight can be an indicator, with weights exceeding 1 kg suggesting lymphoma.
• The procedure offers diagnostic accuracy with a favorable safety profile and potential for symptomatic relief.