Complications in the adult asplenic patient: A review for the emergency clinician

Long, Brit; Koyfman, Alex; Gottlieb, Michael

doi:10.1016/j.ajem.2020.03.049

Cited by 12 publications

(7 citation statements)

References 109 publications

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“…Twenty-one centers reported at least one SPDP (range 1-27; median [IQR]: 2 [7]). DPWS was reported by all thirty-four centers (range 1-123; median [IQR]: 9 [16]). Seventy-six percent of all SPDP procedures were performed in six of the participating centers.…”

Section: Resultsmentioning

confidence: 99%

“…It has been sustained that post-splenectomy infective complications have an age-related impact due to the increased time-at-risk in the case of younger population and a possibly impaired function related to senescence of immune system in the case of the elderly population [15][16][17][18][19][20][21] . In our cohort, we did observe a lower median age in the case of patients who underwent SPDP.…”

Section: Discussionmentioning

confidence: 99%

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Minimally invasive spleen-preserving distal pancreatectomy: real-world data from the Italian National Registry of Minimally Invasive Pancreatic Surgery (IGoMIPS)

Donisi¹,

Capretti²,

Napoli³

et al. 2023

Mini-invasive Surg

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Aim: Minimally invasive distal pancreatectomy has become the standard of care for benign and low malignant lesions. Spleen preservation in this setting has been proposed to reduce surgical trauma and long-term sequelae. The aim of the current study is to present real-world data on indications, techniques, and outcomes of spleen-preserving distal pancreatectomy (SPDP). Methods: Patients who underwent SPDP and distal pancreatectomy with splenectomy (DPWS) were extracted from the 2019-2022 Italian National Registry for Minimally Invasive Pancreatic Surgery (IGoMIPS). Perioperative and pathological data were collected. Results: One hundred and ten patients underwent SPDP and five hundred and seventy-eight underwent DPWS. Patients undergoing SPDP were significantly younger (56 vs. 63.5 years; P < 0.001). Seventy-six percent of SPDP cases were performed in six out of thirty-four IGoMIPS centers. SPDP was performed predominantly for Neuroendocrine Tumors (43.6% vs.23.5%; P < 0.001) and for smaller lesions (T1 57.6% vs. 29.8%; P < 0.001). The conversion rate was higher in the case of DPWS (7.6% vs. 0.9%; P = 0.006), even when pancreatic cancer was ruled out (5.0% vs. 0.9%; P = 0.045). The robotic approach was most commonly used for SPDP (50.9% vs. 29.7%; P < 0.001). No difference in postoperative outcomes and length of stay was observed between the two groups, as well as between robotic and laparoscopic approaches in the SPDP group. A trend toward a lower rate of postoperative sepsis was observed after SPDP (0.9% vs. 5.2%; P = 0.056). In 84.7% of SPDP, splenic vessels were preserved (Kimura procedure) without an impact on short-term postoperative outcomes. Conclusion: In this registry analysis, SPDP was feasible and safe. The Kimura procedure was prevalent over the Warshaw procedure. The typical patient undergoing SPDP was young with a neuroendocrine tumor at an early stage. Robotic assistance was used more frequently for SPDP than for DPWS.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Minimally invasive spleen-preserving distal pancreatectomy: real-world data from the Italian National Registry of Minimally Invasive Pancreatic Surgery (IGoMIPS)

Donisi¹,

Capretti²,

Napoli³

et al. 2023

Mini-invasive Surg

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“…37 The other three deaths occurred lately. Thus, it cannot be determined whether splenectomy contributed to their death 38 or whether the deaths occurred due to the irreversible progression of immune failure resulting from HIV infection before the surgical procedure. Their low CD41 count suggests that they already had a high chance of death without splenectomy, as it occurred with the patient with herpetic encephalitis.…”

Section: Discussionmentioning

confidence: 99%

Splenectomy in Patients with Visceral Leishmaniasis Resistant to Conventional Therapy and Secondary Prophylaxis: A Retrospective Cohort

reinaldo

Araújo-Júnior

Diniz

et al. 2022

The American Journal of Tropical Medicine and Hygiene

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Some patients with visceral leishmaniasis (VL), or kala-azar, suffer relapses and low quality of life despite adequate drug therapy, especially those co-infected with HIV. Occasionally, physicians indicate splenectomy, but the benefit of the procedure needs to be analyzed systematically. Therefore, a retrospective open cohort study was conducted in Teresina, Brazil. Inpatients from a reference hospital with relapsing VL who had a rescue splenectomy between 2012 and 2019 after the nationally recommended drug therapy failed were studied. The procedure’s risks and benefits were assessed in a limited-resource setting. The primary outcomes were surgical complications, complete blood count, CD4+ cell count, hospitalizations, survival time, and medical complications preceding death. Thirteen adult patients received medical and surgical indications of splenectomy (12 men and one woman). Eleven had HIV infection. Two had early and two had late complications. Four died, all of whom were infected with HIV. An additional HIV-coinfected patient, apart from the cohort, died just before surgery. The death rate after surgery was 13.3 overall and 22.1 per 100 person-years among HIV-infected patients (31% overall and 36%, respectively). The impressive rise of complete blood counts and reduction of blood transfusions and hospitalizations were observed among all patients. Also, a meaningful increase in CD4+ cells in HIV-infected patients was noted. Splenectomy may benefit patients with relapsing VL. However, before performing splenectomy, available combined drug therapy should be tried for relapsing VL.

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“…The spleen is a main reticuloendothelial organ providing immune protection and blood filtration function (especially against encapsuled bacteria) [29]. Patients after total splenectomy have increased risks of infections (especially overwhelming postsplenectomy infection), arterial and venous thrombotic disease, pulmonary hypertension, and cancer [30].…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and treatment of splenic torsion in children: preoperative thrombocytosis predicts splenic infarction

Wang

Peng

et al. 2022

BMC Pediatr

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Background Pediatric splenic torsion is a rare entity, and the most common cause is wandering spleen. This study aimed to summarize our clinical experience in the diagnosis and surgical treatment pediatric patients with splenic torsion, and to use preoperative thrombocytosis as a preoperative predictive factor for splenic infarction. Methods From January 1st, 2016 to December 31st, 2021, 6 children diagnosed as splenic torsion were included. All patients were surgically treated and followed up. The clinical data was collected including clinical presentations, laboratory tests, imaging results, surgical procedures, and prognosis. Clinical experience of diagnosis and surgical treatment were summarized. Results There were 4 females and 2 males, with median age at surgery 102.6 (range 9.4–170.7) months. Abdominal pain and abdominal mass were the most common presentations. The diagnosis of splenic torsion depended on imaging studies, and adjacent organ involvement (gastric and pancreas torsion) was observed on contrast CT in one patient. Five patients were diagnosed as torsion of wandering spleen, and one was torsion of wandering accessory spleen. Emergent laparoscopic or open splenectomy was performed in all patients. Pathology revealed total splenic infarction in 4 patients, partial infarction in 1 patient, and viable spleen with congestion and hemorrhage in 1 patient. Preoperative platelet counts were elevated in all 4 patients with splenic infarction, but normal in the rest 2 with viable spleen. Postoperative transient portal vein branch thromboembolism occurred in one patient. Conclusions Imaging modalities are crucial for the diagnosis of pediatric splenic torsion and adjacent organ involvement. Preoperative thrombocytosis may predict splenic infarction. Spleen preserving surgery should be seriously considered over splenectomy in patients with a viable spleen.

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Complications in the adult asplenic patient: A review for the emergency clinician

Cited by 12 publications

References 109 publications

Minimally invasive spleen-preserving distal pancreatectomy: real-world data from the Italian National Registry of Minimally Invasive Pancreatic Surgery (IGoMIPS)

Minimally invasive spleen-preserving distal pancreatectomy: real-world data from the Italian National Registry of Minimally Invasive Pancreatic Surgery (IGoMIPS)

Splenectomy in Patients with Visceral Leishmaniasis Resistant to Conventional Therapy and Secondary Prophylaxis: A Retrospective Cohort

Diagnosis and treatment of splenic torsion in children: preoperative thrombocytosis predicts splenic infarction

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