Splenic Tissue Autotransplantation

Abstract

Letters to the EditorSplenic Tissue Autotransplantation Bernd Domres, MD, Facharzt Ram N. Goel, FRCS, MD M. Heitham Schammut, and MD, Facharzt Robert R. ToussaintMD, Facharzt Bernd Domres Department of Surgery, King Khaled Hospital, P.O. Box 1852, Hail, Saudi Arabia Search for more papers by this author , Ram N. Goel Department of Surgery, King Khaled Hospital, P.O. Box 1852, Hail, Saudi Arabia Search for more papers by this author , M. Heitham Schammut Department of Surgery, King Khaled Hospital, P.O. Box 1852, Hail, Saudi Arabia Search for more papers by this author , and Robert R. Toussaint Department of Surgery, King Khaled Hospital, P.O. Box 1852, Hail, Saudi Arabia Search for more papers by this author Published Online:1 Jul 1988https://doi.org/10.5144/0256-4947.1988.297aSectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionAsplenic patients are at an increased risk of overwhelming bacterial infection. It appears as pneumococcal sepsis in about 2% of splenectomized patients and may occur as late as 20 years after the splenectomy. Mortality in infected patients exceeds 50%, and this high mortality rate is related to the absent splenic functions. Therefore, we autograft removed ruptured spleen into an omentum pouch. This procedure does not extend the operation time more than 10 minutes.After removal of the ruptured spleen, its capsule is removed. The organ is shredded with sharp sterile device (of the type used in the kitchen to shred vegetables). The site of splenic implantation is important. It should be placed in an area that will drain into the portal venous system when neovascularization occurs. Implants function better in an omentum pouch than in a subcutaneous or peritoneal pouch. To avoid the main complications of the procedure (splenosis of the abdominal cavity or adhesions) the omental pouch should be sutured tightly so that it will not leak.We try to reimplant as much tissue of the ruptured spleen as possible. Research into splenic autotransplantation could prove that the minimum total weight of the grafted spleen should exceed 100 g, about a third of the total organ, to preserve satisfactory splenic function.Autotransplantation of ruptured spleen was performed in 49 cases. Eleven of the 49 patients died as a result of accompanying multiple injuries and not due to the splenectomy or autotransplantation.The progress of spleen regeneration in the omental pouch can be monitored by splenic scans, and postoperatively 30 patients were followed with regular thrombocyte counts, blood smears for RBC morphology such as Howell-Jolly bodies and pitted RBCs, and quantitative immunoelectrophoresis of IgM levels. After an initial increase in the numbers of thrombocytes, Howell-Jolly bodies, and pitted RBCs in the first 4 weeks, the levels returned to near normal after 8 weeks. The decreased IgM fraction returned to normal after 6 months.These results encourage us to continue autotransplantation of splenic tissue after splenectomy. Previous article Next article FiguresReferencesRelatedDetails Volume 8, Issue 4July 1988 Metrics History Published online1 July 1988 InformationCopyright © 1988, Annals of Saudi MedicinePDF download