Cases reported "Hypersplenism"

Filter by keywords:



Filtering documents. Please wait...

1/16. Functional, life-threatening disorders and splenectomy following liver transplantation.

    splenectomy (SPL) in cirrhotic patients undergoing liver transplantation (LTx) may resolve specific problems related to the procedure itself, in case of functional and life-threatening clinical situations often occurring as a result of liver cirrhosis and portal hypertension. METHOD: A single-center experience of ten splenectomies in a series of 180 consecutive adult liver transplant patients over a period of 6 yr is reported. The mean patient age was 46.8 /- 9.5 yr (range 25 57 yr). Indications for SPL were post-operative massive ascitic fluid loss (n = 3), severe thrombocytopenia (n = 3), acute intra-abdominal hemorrhage (n = 2), infarction of the spleen (n = 1), and multiple splenic artery aneurysms (n = 1). RESULTS: Extreme ascites production due to functional graft congestion disappeared post-SPL, with an improvement of the hepatic and renal functions. SPL was also effective in cases of thrombocytopenia persistence post-LTx, leading to an increase in the platelet count after about 1 wk. Bleeding episodes related to left-sided portal hypertension or trauma were also resolved. The rejection rate during hospitalization was 0%, and no other episodes were recorded in the course of the long-term follow-up. However, sepsis with a fatal outcome occurred in 4 patients, i.e. between 2 and 3 wk post-SPL in three cases and 1 yr after the procedure as a result of pneumococcal infection in the last case. Fatal traumatic cranial injury occurred 3 yr post-LTx in another case. Five patients (50%) are still alive and asymptomatic after a median follow-up period of 36 months. CONCLUSION: The lowering of the portal flow appears to resolve unexplained post-operative ascitic fluid loss as a result of functional graft congestion following LTx. However, because of the enhanced risk of SPL-related sepsis, a partial splenic embolization (PSE) or a spleno-renal shunt could be used as an alternative procedure because it allows us to preserve the immunological function of the spleen. SPL is indicated in case of post-transplant bleeding due to left-sided portal hypertension and trauma, spleen infarction, and to enable prevention of hemorrhage in liver transplant patients with multiple splenic artery aneurysms. Severe and persistent thrombocytopenia could be treated with PSE. Because the occurrence of fatal sepsis post-SPL is a major complication in LTx, functional disorders, such as ascites and thrombocytopenia, should be treated with a more conservative approach.
- - - - - - - - - -
ranking = 1
keywords = operative
(Clic here for more details about this article)

2/16. Partial splenic embolization in the treatment of hypersplenism.

    Transcatheter embolization of the spleen has been associated with serious complications, such as splenic abscess, rupture of the spleen, pneumonia, and septicemia. These complications, with their grave consequences, have prevented the use of this procedure as an alternative to operative splenectomy in selected cases. A detailed description of our method, which consists of partial splenic embolization, antibiotic prophylaxis, adequate pain control, and careful pre- and postembolization, is reported. Thirteen patients with hypersplenism were successfully treated with transcatheter partial embolization of their spleen.
- - - - - - - - - -
ranking = 0.5
keywords = operative
(Clic here for more details about this article)

3/16. wandering spleen presenting as a right hypochondrial mass and intestinal obstruction.

    This is a case report of a 23 year old multiparous woman who presented with intestinal obstruction and a right hypochondrial mass. Laparatomy revealed an infarcted 1.4 Kg spleen in the right lumbar region compressing the ascending colon. There was also ileal volvulus around the splenic pedicle. This is probably the first documented case of wandering spleen in the right hypochondrium, presenting as right large bowel obstruction, to be reported in our region. wandering spleen is a rare condition, often asymptomatic, but may present as an acute abdomen. Pre-operative diagnosis is difficult and rarely made. Laboratory tests are seldom useful, but imaging studies do assist. Up to 1971 only 350 cases had been reported in the western literature. review of English literature from 1900 to 1991 reported only 51 cases in children. In our region 11 cases were reported in uganda between 1968 and 1971. No other literature is available from our region. Clinical presentation, aetiology, investigation, and management of wandering spleen is discussed.
- - - - - - - - - -
ranking = 0.5
keywords = operative
(Clic here for more details about this article)

4/16. portal vein thrombosis after laparoscopy-assisted splenectomy and cholecystectomy.

    A 12-year-old girl underwent laparoscopy-assisted splenectomy and cholecystectomy with removal of her spleen through a small Pfannenstiel incision. She had an unremarkable postoperative course but returned 16 days later because of increasing right-sided abdominal pain. The pain was constant, sharp, and stabbing without radiation. Abdominal examination showed diffuse right upper quadrant and epigastric tenderness without peritoneal irritation. Laboratory test results included white blood cell count, 14.4 x 10(9)/mm3; hemoglobin, 8.5 g/dL; platelets, 1,483,000; and normal values for lipase, amylase, aspartate transaminase, and alanine transaminase. Evaluation with ultrasonography and vessel Doppler studies showed an occlusive thrombus throughout the portal and splenic veins. The patient underwent intravenous heparin anticoagulation therapy. Her symptoms resolved completely over the next 2 days. The patient is currently receiving warfarin and anagrelide as an outpatient (international normalized ratio, 2). There were no long-term complications caused by portal vein thrombosis. This is the first reported case of portal vein thrombosis after laparoscopic splenectomy in the pediatric population.
- - - - - - - - - -
ranking = 0.5
keywords = operative
(Clic here for more details about this article)

5/16. Laparoscopic splenectomy for variceal bleeding with non-cirrhotic portal vein thrombosis: a case report.

    A 57-year-old man was referred to our hospital for treatment of refractory gastric bleeding from gastric varices secondary to portal vein thrombosis. The patient's liver function tests and coagulation profile were normal. The venous phase of the superior mesenteric arteriogram, on the other hand, showed superior mesenteric vein-portal vein occlusion with surrounding hepatopetal variceal collaterals. The venous phase of the splenic arteriogram additionally showed splenic vein occlusion and collateral vessels from the gastric and retroperitoneal regions flowing into a portal cavernous transformation. gastroscopy confirmed that the patient had gastric varices in the cardia. We performed laparoscopic splenectomy to treat refractory gastric bleeding from varices and symptomatic hypersplenism. The postoperative course was uneventful; the patient's gastric varices were less prominent on follow-up gastroscopy and the hematologic profile returned to normal. Extrahepatic portal vein thrombosis is the leading cause of variceal hemorrhage in patients with healthy livers. There is a consensus in the literature that splenectomy alone is of minimal value in preventing variceal bleeding in portal vein thrombosis. splenectomy is, however, indicated in cases in which the patient has hepatopetal collaterals from the mesenteric vein system and whose hemorrhagic gastric varices are related to splenic vein thrombosis as in our case.
- - - - - - - - - -
ranking = 0.5
keywords = operative
(Clic here for more details about this article)

6/16. Successful pregnancy outcome in a patient with congenital biliary atresia.

    Congenital biliary atresia is one of the most common congenital anomalies of the biliary tree. Without surgical correction, two-thirds of all cases of extrahepatic biliary atresia are fatal within 18 months. Historically, the preferred surgical procedure to correct this anomaly has been the Kasai procedure. Surgical treatment of congenital biliary atresia is associated with substantial perioperative morbidity and mortality, as well as long-term sequelae. Portal hypertension and hypersplenism can complicate the course of up to 50% of patients who survive for more than 2 years. Not surprisingly, few of these patients reach adulthood. We report the case of a woman with congenital biliary atresia surgically corrected with the Kasai operation who subsequently reached adulthood and became pregnant. Despite a prenatal course complicated by portal hypertension, bleeding esophageal varices, and hypersplenism, the woman delivered a healthy infant at 36.5 weeks' gestation.
- - - - - - - - - -
ranking = 0.5
keywords = operative
(Clic here for more details about this article)

7/16. Laparoscopic splenectomy for the treatment of wandering spleen.

    wandering spleen is a very rare pathologic condition that initially presents with unremarkable clinical symptoms, then dramatically manifests severe complications. A case of wandering spleen treated with laparoscopic splenectomy is described and compared with other similar reports in the literature. Laparoscopic exploration of the abdominal cavity allowed the diagnosis to be confirmed and splenectomy to be performed. An enlarged spleen led to the choice of total splenectomy to avoid both future complications and future organ torsion resulting from the long and twisted vascular pedicle. The laparoscopic approach led to a rapid recovery, a 3-day postoperative course, and satisfactory cosmetic results.
- - - - - - - - - -
ranking = 0.5
keywords = operative
(Clic here for more details about this article)

8/16. Severe thrombocytopenia due to hypersplenism successfully treated with partial splenic embolization in preoperative management.

    hypersplenism is a known complication of portal hypertension secondary to cirrhosis of the liver. Although thrombocytopenia secondary to hypersplenism does not cause clinically significant hemostatic defect, it may need to be addressed in selective circumstances, such as preoperative preparation for a surgery. This report describes a 30-year-old male with a history of cirrhosis of the liver and hypersplenism who had a recurrence of craniopharyngioma. A platelet count of 40 x 10(9)/L limited his treatment options. A stereotactic injection of radioactive P32 into the tumor was planned but was thought not to be feasible because of the thrombocytopenia. The thrombocytopenia responded favorably to partial splenic embolization, and the patient underwent successful stereotactic injection of radioactive P32 into the tumor.
- - - - - - - - - -
ranking = 2.5
keywords = operative
(Clic here for more details about this article)

9/16. Protracted pain following partial splenic embolization in an adolescent female with hypersplenism.

    A 17-year-old female with massive splenomegaly underwent partial splenic embolization (PSE) for hypersplenism. The postoperative course was characterized by recurrent painful splenic infarctions requiring hydromorphone PCA for an extended period resulting in an unanticipated, prolonged hospital stay. Massive splenomegaly treated with PSE may require an extended hospital stay to achieve pain control. Such patients may subsequently require transition to enteral opioids and weaning.
- - - - - - - - - -
ranking = 0.5
keywords = operative
(Clic here for more details about this article)

10/16. Effectiveness of Rex shunt in the treatment of portal hypertension.

    BACKGROUND: Children with portal venous thrombosis often have severe symptoms secondary to portal hypertension including recurrent upper gastrointestinal (UGI) bleeds and hypersplenism. We report results of the use of the mesenterico-left portal bypass (Rex shunt) in 5 consecutive patients. methods: A retrospective chart review of all patients with portal venous thrombosis who underwent Rex shunt procedure was performed. Children were evaluated preoperatively with magnetic resonance angiogram, Doppler ultrasound, and mesenteric angiogram. Postoperative ultrasounds were performed in follow-up. RESULTS: All patients had evidence of portal hypertension and hypersplenism. The average age of the patients was 13.2 /- 4.9 (7-19) years. The patient had an average of 2.6 /- 1.7 UGI bleeds requiring banding and 3.4 /- 4.2 U of blood transfused before undergoing the shunt. The mean operative time was 383 /- 46 minutes, and length of stay was 10.4 /- 7.1 days. In follow-up of 18.8 /- 5.2 months (11-24 months), all but 1 patient had a patent shunt. One narrowed shunt was successfully dilated by percutaneous angioplasty. thrombocytopenia improved significantly in patients with functioning shunts but did not correlate with a significant decrease in splenic size. CONCLUSIONS: The Rex shunt reestablishes normal hepatopedal portal flow, and in patients with functioning shunts, no recurrent UGI bleeds or transfusions were required or evidence of encephalopathy were noted.
- - - - - - - - - -
ranking = 1.5
keywords = operative
(Clic here for more details about this article)
| Next ->


Leave a message about 'Hypersplenism'


We do not evaluate or guarantee the accuracy of any content in this site. Click here for the full disclaimer.