Klinische Relevanz von Nebenmilzen nach elektiven und notfallmäßigen Splenektomien

Abstract

Clinical Relevance of Accessory Spleens Following Elective and Emergency Splenectomies Background: With respect to the various functions of the spleen, a careful risk-benefit analysis must be done before splenectomy. Methods: During 10 years, 211 splenectomies were carried out in our hospital. In 185 of these clinical cases the documents were complete for an analysis. Results: The most frequent indications for surgical treatment were immunothrombocytopenia (22.2%) and lymphogranulomatosis (18.9%) followed by spleen bleedings (24.3%) of traumatically, iatrogenic or spontaneous origin. Postoperative complications such as pulmonary and cardiological disorders, disorders in wound healing, and abscesses could be found in 31.3% of the elective and in 80.4% of the emergency cases. 5.2 and 21.9% of the patients died after elective treatment and emergency surgery, respectively, resulting in an overall mortality of 10.8%. In the latter group death was mostly related to the severe concomitant injuries. The main problem during the postoperative period is the high rate of infections which could be attributed to the loss of an immunologically active organ. Postoperative thrombocytosis was temporary in most cases. A sepsis developed in 4.9% of the patients with a lethal outcome in 2.7% of the cases. 13.5% of the patients showed accessory spleens. In those patients suffering from immunothrombocytopenia and lymphogranulomatosis, they were even found in 22 and 20% of the cases, respectively. 12.1% of the 58 reinspected patients showed accessory spleens; some of them even had multiple accessory spleens. Mostly, solitary accessory spleens were found. They were located in the neighborhood of the spleen or – after splenectomy – in the former spleenic area. The size of accessory spleens ranged between some millimeters and 5 cm with an average length of about 1–2 cm. Accessory spleens were either completely unobtrusive with no function at all, or they can take over some spleenic functions, regardless of their size and location. Especially in combination with immunothrombocytopenia, they may be responsible for the failure of an otherwise successful splenectomy. However, relapses after splenectomy could not generally be attributed to accessory spleens since relapses also occurred after additional exstirpation of accessory spleens. Conclusion: As some accessory spleens take over specialized functions of the spleen while others remain unobtrusive, the benefit of splenectomy for the treatment of blood-related malignancies is hardly foreseeable.