Indications for Surgery in Non-Traumatic Spleen Disease

Coco, Danilo; Leanza, Silvana

doi:10.3889/oamjms.2019.568

Cited by 9 publications

(5 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As the largest lymphatic organ, the spleen's functions are filtration of foreign matters from blood, antibody production, and bacteria control [1]. Removal of the spleen (splenectomy), mostly due to blunt splenic injury [2], hypersplenism [3,4], and functional hyposplenism [5][6][7] in some conditions (coeliac disease, inflammatory bowel disease, and sickle cell anemia) [8] can lead to several bacterial infections, including Klebsiella pneumoniae, Hemophilus influenzae, and Pseudomonas aeruginosa [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Enhanced Bacteremia in Dextran Sulfate-Induced Colitis in Splenectomy Mice Correlates with Gut Dysbiosis and LPS Tolerance

Thim-Uam

Makjaroen

Issara-Amphorn

et al. 2022

IJMS

View full text Add to dashboard Cite

Because both endotoxemia and gut dysbiosis post-splenectomy might be associated with systemic infection, the susceptibility against infection was tested by dextran sulfate solution (DSS)-induced colitis and lipopolysaccharide (LPS) injection models in splenectomy mice with macrophage experiments. Here, splenectomy induced a gut barrier defect (FITC-dextran assay, endotoxemia, bacteria in mesenteric lymph nodes, and the loss of enterocyte tight junction) and gut dysbiosis (increased Proteobacteria by fecal microbiome analysis) without systemic inflammation (serum IL-6). In parallel, DSS induced more severe mucositis in splenectomy mice than sham-DSS mice, as indicated by mortality, stool consistency, gut barrier defect, serum cytokines, and blood bacterial burdens. The presence of green fluorescent-producing (GFP) E. coli in the spleen of sham-DSS mice after an oral gavage supported a crucial role of the spleen in the control of bacteria from gut translocation. Additionally, LPS administration in splenectomy mice induced lower serum cytokines (TNF-α and IL-6) than LPS-administered sham mice, perhaps due to LPS tolerance from pre-existing post-splenectomy endotoxemia. In macrophages, LPS tolerance (sequential LPS stimulation) demonstrated lower cell activities than the single LPS stimulation, as indicated by the reduction in supernatant cytokines, pro-inflammatory genes (iNOS and IL-1β), cell energy status (extracellular flux analysis), and enzymes of the glycolysis pathway (proteomic analysis). In conclusion, a gut barrier defect after splenectomy was vulnerable to enterocyte injury (such as DSS), which caused severe bacteremia due to defects in microbial control (asplenia) and endotoxemia-induced LPS tolerance. Hence, gut dysbiosis and gut bacterial translocation in patients with a splenectomy might be associated with systemic infection, and gut-barrier monitoring or intestinal tight-junction strengthening may be useful.

show abstract

Section: Introductionmentioning

confidence: 99%

Enhanced Bacteremia in Dextran Sulfate-Induced Colitis in Splenectomy Mice Correlates with Gut Dysbiosis and LPS Tolerance

Thim-Uam

Makjaroen

Issara-Amphorn

et al. 2022

IJMS

View full text Add to dashboard Cite

show abstract

“…Therefore, management should be aggressive, with early surgical intervention and hemoderivative support 6,7 . Unlike patients with traumatic splenic rupture, who may prefer conservative treatment to preserve splenic function or splenorraphy as a repair technique, patients with spontaneous rupture will always require splenectomy for resolution 7,[10][11][12] . When the spleen exceeds 1000-2000 g, as in the case presented here, laparoscopic splenectomy becomes technically complicated, so an open procedure would be indicated 13 .…”

Section: Discussionmentioning

confidence: 99%

Splenic rupture after anticoagulant therapy in a patient with a history of COVID-19: a case report

López-Almanza,

Andrade-Martínez-Garza,

González-Hermosillo-Cornejo

et al. 2024

CIRUE

View full text Add to dashboard Cite

We present the case of a 75-year-old man with a history of COVID-19 and splenic infarct treated with enoxaparin, who presented with intense abdominal pain and tomographic findings of free peri-splenic fluid and a hyperdense image in the spleen. An emergency laparotomy was performed, with findings of a splenic rupture at the vascular hilum. Spontaneous splenic rupture is a rare and fatal entity that should be suspected in a patient with history of COVID-19 who presents with acute abdominal pain after the administration of heparin.

show abstract

“…Splenectomy has well established indications in surgical literature, as part of surgical intervention for indications like trauma, malignancy, splenic abscess etc [ 4 , 5 ]. With increasing evidence of central role of spleen in immunological functions in body, the emphasis is more on splenic conservation, rather than splenectomy.…”

Section: Discussionmentioning

confidence: 99%

Splenectomy in Thalassemia: The Role of Surgery as an Adjunct to Medical Management

Kumar,

Chauhan

2024

Cureus

View full text Add to dashboard Cite

Introduction Beta thalassemia is a hemoglobinopathy characterized by defective production of the beta chain of hemoglobin, leading to irreversible destruction of RBCs, splenomegaly, pancytopenia, and a requirement for multiple transfusions. This condition necessitates iron chelation therapy, and splenectomy is often performed to manage hypersplenism. Methods This report includes a series of seven diagnosed cases of beta thalassemia with hypersplenism, all of whom underwent open splenectomy. Preoperative transfusions were administered to achieve target hemoglobin and platelet counts of 9 g/dL and 50,000/µL, respectively. Results The study included seven patients diagnosed with beta thalassemia, all of whom underwent open splenectomy. Among these, three patients also had concomitant cholecystectomy due to the presence of gallstones. The primary indication for performing splenectomy was hypersplenism. Preoperative transfusions were administered to ensure target hemoglobin levels of 9 g/dL and platelet counts of 50,000/µL. All patients were successfully discharged with minimal morbidity and no reported mortality. The longest follow-up period observed in this series was 10 months post-splenectomy, which limited the assessment of long-term effects. Conclusion Open splenectomy for hypersplenism in patients with beta thalassemia appears to be a safe and effective procedure with minimal short-term morbidity and no mortality observed in this series. However, due to the limited follow-up duration, the long-term effects of splenectomy in these patients could not be evaluated. Further studies with longer follow-up are needed to assess the long-term outcomes of splenectomy in beta thalassemia patients.

show abstract

Indications for Surgery in Non-Traumatic Spleen Disease

Cited by 9 publications

References 29 publications

Enhanced Bacteremia in Dextran Sulfate-Induced Colitis in Splenectomy Mice Correlates with Gut Dysbiosis and LPS Tolerance

Enhanced Bacteremia in Dextran Sulfate-Induced Colitis in Splenectomy Mice Correlates with Gut Dysbiosis and LPS Tolerance

Splenic rupture after anticoagulant therapy in a patient with a history of COVID-19: a case report

Splenectomy in Thalassemia: The Role of Surgery as an Adjunct to Medical Management

Contact Info

Product

Resources

About