| Splenectomy:
|
A
splenectomy is
a procedure that involves the removal
of the spleen by operative means.
|
Indications
The spleen, similar
in structure to a large lymph node, has
historically held rather a mythical role
but current knowledge of its purpose includes
the destruction of old red blood cells
and platelets and the detection and fight
against certain bacteria. The spleen is
enlarged in a variety of conditions such
as malaria, glandular fever and most commonly
in "cancers" of the lymphatics
such as lymphomas or the leukaemia.
It is removed
under the following circumstances:
When very large
such that it becomes destructive to platelets/red
cells
For diagnosing certain lymphomas
-
When platelets are destroyed in the
spleen as a result of an auto-immune
process (see also idiopathic thrombocytopenic
purpura)
-
When the spleen bleeds following physical
trauma
-
Following spontaneous rupture
-
For long-term treatment of congenital
erythropoietic porphyria (CEP) if severe
hemolytic anemia develops
The classical
cause of traumatic damage to the spleen
is a motorcycle accident where one end
of the handlebars strikes the abdomen.
Procedure
In general, spleens
are removed by laparoscopy (minimal access
surgery) when the spleen is not too large
and when the procedure is elective. It
is performed by open surgery for trauma
or large spleens. Both methods are major
surgeries, and are performed under general
anesthesia. The spleen is located and
disconnected from its arteries. The ligaments
holding the spleen in place are dissected
and the spleen is removed. When indicated
a drain is left in place and the incision(s)
is closed. If necessary, tissue samples
are sent to a laboratory for analysis.
Side effects
Because splenectomy
causes an increased risk of overwhelming
sepsis due to encapsulated organisms (such
as S. pneumoniae and Haemophilus influenzae)
the patient should be immunized, if possible,
prior to removal of the spleen; see asplenia
for advice.[2][3] Failure to do so later
puts the patient at risk of overwhelming
post-splenectomy infection (OPSI), a potentially
rapidly fatal septicaemia. These bacteria
often cause a sore throat under normal
circumstances but after splenectomy, when
infecting bacteria cannot be adequately
opsonized, the infection becomes more
severe.
Following splenectomy,
the platelet count may rise to high levels
in blood leading to an increased risk
of clot formation and death.
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