Overwhelming Postsplenectomy Infection Research Articles

Left-sided portal hypertension caused by a solid pseudopapillary neoplasm of pancreas tail: a pediatric case report

BackgroundSolid pseudopapillary neoplasm (SPN) is a low-grade malignant tumor that occurs in 60% of all pediatric pancreas tumors. Radical tumor resection is essential; however, spleen preservation is also crucial to prevent overwhelming post-splenectomy infection. In contrast, spleen preservation is not always possible, because left-sided portal hypertension (LSPH) can cause splenic vein stenosis or occlusion induced by pancreatic tumor. We herein report on a pediatric patient of LSPH due to SPN in the pancreatic tail.Case presentationA 12-year-old girl was admitted to our hospital with left upper quadrant abdominal pain. A solid mass was palpated in the left costal region. The patient showed slight anemia (Hb: 11.8 g/dL) and elevation of inflammatory reaction (CRP: 5.98 mg/dL) without positive tumor markers. A radiological examination revealed that a 9 cm-sized mass with hemorrhagic necrosis in the pancreatic tail. Splenic venous flow was not detected and collateral draining into the left gastric vein and left renal veins were developed with splenomegaly. LSPH was involved at the time of diagnosis. The tumor was diagnosed with SPN, hence tumor resection with spleen preservation was performed. Six months after surgery, the patient developed a left quadrant abdominal pain that worsened during exercise. There was no improvement of splenic venous flow and splenomegaly. LSPH remained with splenomegaly, which possibly triggered the patient’s abdominal pain. The patient underwent splenectomy 9 months after the tumor resection. After the splenectomy, the patient’s abdominal pain disappeared without any recurrence 8-year post-surgery.ConclusionsLSPH has not been a major focus in previous SPN pediatric patients, although most symptomatic LSPH patients required splenectomy. Careful post-operative observation for LSPH is important for pediatric SPN patients.

236 Post-Splenectomy Patients: Reaudit of Current Practice at Living Well Partnership PCN

Abstract Aim Post-splenectomy patients are at increased risk of sepsis and overwhelming post-splenectomy infection (OPSI). This reaudit aimed to look at a primary care network’s (PCN) compliance with established immunisation guidelines and antibiotic prophylaxis post-splenectomy. Method A retrospective study of 29 splenectomy or asplenia patients between 2018-2022 was conducted within a primary care network. Hospital and GP records were reviewed for antibiotic prescriptions (prophylactic and emergency), vaccination records, electronic splenectomy alert and admission for infection. Interventions included a 15-minute patient intervention GP consultation and correction of EMIS coding. Results The 2018 audit showed that a proportion of splenectomy patients were not appropriately prescribed antibiotics. There was lack of patient insight into their condition (asplenia v splenectomy). An active, patient-centred intervention was employed to improve rates of antibiotic prescribing, perform counselling on regular recommended vaccinations and ensure correct clinical coding for follow up. Compliance to audit criteria increased across all measures between the 3 PDSA cycles. Antibiotic prophylaxis prescription increased from 53% (2018) to 71% in 2022. Emergency antibiotic prescription increased from 6% (2018) to 39% in 2022. Influenza vaccination rates increased from 71% (2018) to 82% in 2022. Following the intervention consultation, 85% of patients had appropriate antibiotic prophylaxis prescription and 64% had appropriate emergency antibiotics prescribed. Conclusions Prescription for emergency and prophylactic antibiotics, and correct coding for annual and 5-year vaccinations were improved for this cohort of splenectomy and asplenia patients. Patients valued a structured consultation leading to improved understanding and self-management.

Splenic hamartomas in children.

Splenic hamartomas (SHs) are uncommon, benign vascular lesions of unclear etiology and are mostly found incidentally on abdominal images, at surgery, or at autopsy. Since the first case description, in 1861, less than 50 pediatric SH cases have been reported in the literature. In this article, we have performed an analysis of all SH cases in children published in the literature to date and presented our case of an 8-year-old male with SH. These lesions in children were shown to cause symptoms more often than in the adult population. The observed SH sizes in children ranged from a few millimeters to 18 cm, and the symptomatic lesions were mostly larger or multiple. The most common clinical finding was splenomegaly. Signs of hypersplenism were present in children with a single SH larger than 4.5 cm (diameter range: 4.5-18.0 cm) and in those with multiple hamartomas, ranging from a few millimeters to 5 cm. Eighty percent of patients with available laboratory findings had hematological abnormalities such as anemia, thrombocytopenia, or pancytopenia. Other symptoms and signs included abdominal pain, recurrent infections, fever, night sweats, lethargy, growth retardation, and weight loss. The use of multiple imaging modalities may suggest the preoperative diagnosis of a splenic mass in children and determine the therapeutic approach. However, the final diagnosis of SH relies on histopathological evaluation. Surgery, including total or partial splenectomy (PS), is the mainstay of SH management. Although total splenectomy carries a greater risk of overwhelming post-splenectomy infection than PS it has remained the most performed surgical procedure in children with SH. In the majority of pediatric patients with symptomatic SH, resolution of symptoms and resolution or improvement of cytopenias occurred after surgical treatment.

A Clinical Review and Experience of Splenic Trauma in North India: A Retrospective Observational Study.

The spleen is one of the frequently injured solid organs in abdominal blunt trauma. The standard of care is nonoperative nowadays depending on the hemodynamic stability (World Society of Emergency Surgery (WSES) grade I-III) of the patient due to advancements in treating modalities. Operative interventions are required in hemodynamically unstable patients or failure of nonoperative management. The study was planned to find the clinical spectrum of abdominalblunt trauma, specifically those having splenic trauma, and their subsequent management in an institution. This is a retrospective observational study. All included patients with blunt abdominal injuries were treated in a level 1 trauma center between July 2021 and December 2022. Data regarding demographic profile, blood transfusion, pre- and postoperative findings, and management including the period of hospital stay, morbidity, and mortality were collected and analyzed. One hundred sixty-four patients were analyzed, of which 142 were males and 22 were females. The commonest mechanism of injury was motor vehicle collision, followed by falls. Grade III splenic injury was the most common injury, while the predominantly associated injury was rib fracture. The patients were managed preferably through nonoperative management, followed by angioembolization and operative management. The commonest postoperative complication was pneumonia. Nonoperative management of splenic trauma has evolved as the standard of care replacing operative management in order tosustain its immune function, thereby preventing overwhelming post-splenectomy infection.

Purpura fulminans – meningococcal infection or postsplenectomy sepsis

The article presents two clinical cases with description of peculiarities of septic infection occurred after splenectomy and due to congenital splenic hypoplasia.Decreased immune defense resulted from splenectomy leads to severe infections with a high risk of death. The most severe sequela is overwhelming postsplenectomy infection (OPSI-syndrome) which is characterized by high mortality rate (50-70%) within 12-24 hours from the onset of the first symptoms. The main risk factors of postsplenectomy sepsis are a condition which became an indication for splenectomy, the immune status of the patient, age and the time period after splenectomyStreptococcus pneumoniae, Haemophilus infuenzae type b, Neisseria meningitidis are commonly identified etiological factors of OPSI-syndrome. The diagnosis could be delayed due to nonspecific flu-like prodromal symptoms of the OPSI-syndrome. Delay in the diagnosis and treatment of sepsis may increase the risk of death.One of the syndromes associated with post-splenectomy sepsis is fulminant purpura (purpura fulminans), which requires differential diagnosis with meningococcal infection. However, half of the cases of fulminant pneumococcal purpura occur in patients with asplenia or hyposplenia. In the first clinical case, a preliminary diagnosis of generalized meningococcal infection was made on admission, but the diagnosis of pneumococcal infection could not be excluded in asplenic patient and was subsequently confirmed by laboratory tests.Given the high risk of fulminant postsplenectomy sepsis, and the difficulties of timely diagnosis, the preventive strategy of infections after splenectomy falls into three major categories- vaccination, antibiotic prophylaxis, and patient (patient’s parents) education.Improving healthcare workers’ knowledge is required to ensure prompt diagnosis of hyposplenism, adequate risk assessment of postplenectomy infection and prevention of OPSI-syndrome.

Recent trends in organ-preserving pancreatectomy: Itsproblems and clinical advantages compared with other standard pancreatectomies.

In this review article, we focus on recent papers on organ-preserving pancreatectomy procedures published since 2010. When comparing central pancreatectomy (CP) and distal pancreatectomy (DP), most studies have concluded that the CP group exhibited significantly lower incidence of new-onset diabetes or diabetes exacerbation than the DP group postoperatively. However, because of increased incidence of morbidities such as pancreatic fistula, the surgeon faces a considerable trade-off between increased short-term morbidity and long-term preservation of endocrine function. When the outcomes of two types of spleen-preserving DP (Kimura and Warshaw procedures) are compared, most studies mentioned the low incidence of postoperative gastric varices and splenic infarction with the Kimura procedure. Although there are several reports regarding the effect of spleen preservation on prevention of postoperative infections, no report on the contribution of spleen preservation to the prevention of overwhelming post-splenectomy infection is seen. The advantages of duodenum-preserving pancreatic head resection (DPPHR) concerning endocrine and exocrine functions continue to be subjects of discussion, mainly due to the limited number of institutions that have adopted this approach; however, DPPHR should be presented as an option for patients due to its low incidence of postoperative cholangitis. Organ-preserving pancreatectomy requires meticulous surgical techniques, and postoperative complications may increase with this surgery compared with standard pancreatectomy, which may be influenced by the surgeon's skill and the surgical facility where the procedure is performed. Nonetheless, this technique has significant long-term advantages in terms of endocrine and exocrine functions and its wider adoption in the future is expected.

Spleen-preserving pancreatectomy with removal of splenic vessels: impact on splenic parenchyma ?

BackgroundWhile outcomes after spleen-preserving distal pancreatectomy (SP-DP) have been widely reported, impacts on splenic parenchyma have not been well studied. This study aimed to compare postoperative outcomes, particularly spleen-related outcomes, by assessing splenic imaging after SP-DP with or without splenic vessels removal.MethodsData for all patients who underwent SP-DP with splenic vessels removal (Warshaw technique, WDP) or preservation (Kimura technique, KDP) between 2010 and 2022 in two tertiary centres were retrospectively analysed. Splenic ischemia and volume at early/late imaging and postoperative outcomes were reviewed.ResultsEighty-seven patients were included, 51 in the WDP and 36 in the KDP groups. Median Charlson’s Comorbidity Index was significantly higher in the WDP group compared with the KDP group. Postoperative morbidity was similar between groups. There was more splenic ischemia at early imaging in the WDP group compared to the KDP group (55% vs. 14%, p = 0.018), especially severe ischemia (23% vs. 0%). Partial splenic atrophy was observed in 29% and 0% in the WDP and KDP groups, respectively (p = 0.002); no complete splenic atrophy was observed. Platelet levels at POD 1, 2 and 6 were significantly higher in the WDP group compared to KDP group. At univariate analysis, age, Charlson Comorbidity Index, platelet levels at POD 6, and early splenic infarction were prognostic factors for development of splenic atrophy. No episodes of overwhelming post-splenectomy infection or secondary splenectomy were recorded after a median follow-up of 9 and 11 months in the WDP and KDP groups, respectively.ConclusionsSplenic ischemia appeared in one-half of patients undergoing SP-DP with splenic vessels removal at early imaging, and partial splenic atrophy in almost 30% at late imaging, without clinical impact or complete splenic atrophy. Age, Charlson Comorbidity Index, platelet levels at POD 6, and early splenic infarction could help to predict the occurrence of splenic atrophy.

Giant splenic cyst: A case series of rare and challenging cases from the last 22 years

Introduction and importanceSplenic cyst is a rare disease, with reported incidences ranging from 0.07 to 0.3 %. A splenic cyst is typically discovered inadvertently and may not cause any symptoms until it grows to a significant size. In some cases, complications such as acute abdomen may be brought on by an intracystic hemorrhage, rupture, or infection. As a rare disease, diagnosing a splenic cyst is still precarious because only a few cases have been reported. Case presentationThe first case is a 23-year-old Asian man without a significant history of illness who complains of a left upper quadrant mass that he discovered 10 years prior. Since then, the mass had been gradually growing and had been accompanied by severe pain. Walking made the pain worse; lying down made it lessen. A computed tomography (CT) scan of the abdomen showed a 20.05 × 15.95 × 26.71 cm splenic cyst. Surgery for a peri-cystic splenectomy was done. A primary splenic cyst was identified in the specimen after microscopic and macroscopic examination. After 10 days, the patient was released from the hospital without complications. The second case is that of a 28-year-old Asian man who complained of a mass in their abdomen that was getting bigger in size. Four years prior to the complaint, the patient had fallen while driving a motorcycle, and the left side of his abdomen collided with the sidewalk. In this patient, a splenectomy—the complete removal of all spleen parts—was done. The specimen's macroscopic and microscopic examination revealed a splenic pseudocyst. The patient was discharged after three days without complications. Clinical discussionSplenic cysts are considered rare and challenging to diagnose, as there have been only a limited number of reports. Nevertheless, proper management is still needed, as it carries the risk of rupturing and causing complications such as peritonitis and anaphylactic reactions. Considering the risk of overwhelming post-splenectomy infection (OPSI), conservative treatment can be the gold standard for splenic cysts. However, considering the risk from the size of the cyst, splenectomy or peri-cystic splenectomy is an appropriate surgery option for a splenic cyst. ConclusionSplenectomy, or peri-cystic splenectomy, is a surgery option for a splenic cyst with significant size and rupture risk.

Vaccine coverage for recommended vaccines among splenectomised patients in Apulia, South Italy: a retrospective cohort study

ObjectiveSplenectomised/asplenic patients have a 10–50 fold higher risk than the general population of developing overwhelming postsplenectomy infection. To control this risk, these patients have to receive a specific immunisation schedule,...

A prospective observational study on clinical review of splenic trauma at government medical college, Jammu

Background: The spleen is one of the intra-abdominal solid organs that is most usually wounded. If not detected at an early stage, the patient may present with shock. Even though treatment depends on the severity of splenic damage, stabilizing the patient remains the primary objective. The operational procedures, which may be splenorrhaphy or splenectomy, are performed using an open or laparoscopic approach. Aim and Objectives: The purpose of this study is to examine cases of splenic trauma as well as its treatment methods. We also wish to investigate the numerous causes, clinical characteristics, therapy strategies, and consequences of splenic trauma. Methods: A prospective observational research was conducted on 100 individuals with splenic damage. The trial duration was fifteen months. According to protocol, patients with clinical and radiological evidence of splenic trauma were categorized and provided either operational or non-operative therapy. During the hospital stay, both surgical and nonsurgical outcomes were examined and followed up on. Results: One hundred individuals were examined, including 72 men and 28 women. Road traffic accidents were the leading cause of injuries, followed by falls. The most prevalent injury was a grade III, whereas the most common accompanying injury was a rib fracture. Pneumonia was a common postoperative consequence. Conclusions: After a blunt abdominal injury in a young population, splenic damage is a genuine danger. After splenectomy, vaccination and the risk of OPSI (Overwhelming post-splenectomy infection) must always be considered. Early detection and prompt treatment of splenic trauma can save the patient's life.

Splenic Hydatid Cyst- A Case Report

Asymptomatic hydatid cyst presents as an incidental finding. It is caused by Echinococcus granulosus. The liver is known to be involved organ, while the spleen is rarely involved. Hydatid cyst of the spleen should be considered as one of the differential diagnosis in patients presenting with left hypochondriac pain.This poses a clinical challenge. The decision on conservation or surgery is also a dilemma. To decrease incidence of Overwhelming Postsplenectomy Infection (OPSI) for elective splenectomy, vaccination protocol should be followed. It is important for the clinician to bear in mind the possibility of incidental asymptomatic splenic hydatid cyst and management protocols. Authors, hereby reports, a case of 26-year-old lady with complain of left hypochondriac pain, diagnosed with Ultrasound Sonography (USG) and Contrast Enhanced Computed Tomography (CECT) scan as splenic hydatid cyst. The patient underwent splenectomy after completion of vaccination to avoid OPSI. At six month follow-up the patient was asymptomatic.

HPB P64 An audit on the appropriate prescribing of antimicrobial prophylaxis and vaccinations in patients who underwent a splenectomy by the hepatobiliary department at University Hospital Southampton between January 2020 and April 2022

Abstract Background Patients who have an absent or dysfunctional spleen are at risk of overwhelming post splenectomy infection (OPSI), a condition associated with high mortality rates. The incidence of OPSI ranges from 0.1% to 8.5% (1). This is most commonly from Streptococcus pneumoniae but also from Haemophilus influenzae type b (Hib) and Neisseria meningitidis (2). These infections can have a sudden onset and run a fulminant course. The highest risk of infection is in childhood, age over 50 years old and in the first two years post splenectomy (3). Indications for splenectomy include trauma and malignancy. It is strongly advised that these patients have antibiotic prophylaxis and appropriate vaccinations administered to reduce the risk of OPSI. In University Hospital Southampton (UHS), the hepatobiliary department carry out elective splenectomies usually together with distal pancreatectomies and also do emergency splenectomies due to trauma (4). An audit was carried out at UHS to assess prescribing of antimicrobial prophylaxis and vaccinations in patients undergoing elective and emergency splenectomies by the hepatobiliary department at University Hospital Southampton between January 2020 and April 2022. Methods Patients who underwent a splenectomy at UHS between January 2020 and April 2022 were selected. The hospital inpatient record (CHARTs), e-prescribing record (JAC) and GP record (CHIE) were used to evaluate if patients received appropriate antimicrobial prophylaxis and appropriate vaccinations as per national and local guidelines detailed below. For patients undergoing an elective splenectomy, the pneumococcal vaccine (Pneumovax) should be given at least two weeks prior to surgery (2, 5). If this is not possible, and in emergency scenarios, patients should be given Pneumovax, the meningococcal ACWY vaccine (Menveo) and the meningococcal group B vaccine (Bexsero) two weeks post-surgery. A second dose of Bexsero should be given one month after this. Patients should have a booster dose of Pneumovax every five years and the Influenza vaccine yearly. Patients should receive intravenous benzylpenicillin or clarithromycin twice a day until the patient can take oral medication. This can be switched to phenoxymethylpenicillin twice a day or erythromycin twice a day. This should continue for two years or lifelong if they are in the ‘at risk’ group which includes; over 50 years old or under 16 years old, history of previous invasive pneumococcal disease and patients previously treated for haematological malignancy. Results 88 patients underwent a splenectomy between January 2020 and April 2022. 3% of patients had emergency surgery; the rest were elective cases. Indications for splenectomy included pancreatic cancer, intraductal papillary mucinous neoplasm (IPMN), splenic B cell lymphoma, pancreatitis, gastric varices, metastatic ovarian cancer and metastatic renal carcinoma. 21% of patients did not receive Pneumovax and 22% of patients did not receive Bexsero two weeks post-surgery. 23% of patients did not receive ACWY and 34% of patients did not receive the second dose of Bexsero 4 weeks post discharge. 30% of patients did not receive their yearly Influenza vaccination. Overall, 21% of patients received no vaccinations. 1% of patients did not receive prophylactic antibiotics on discharge. 39% of patients’ discharge paperwork did not have appropriate documentation about when vaccinations needed to be administered. Conclusions Compliance rates of vaccinations and antimicrobial prophylaxis should be 100% to prevent overwhelming post splenectomy infection. Data collection on patients who do not have a CHIE record proved difficult. While collecting data, it was noted that there has been guideline change between 2020 and 2021; In 2020, the ACWY vaccination was recommended to be administered 4 weeks post splenectomy. In 2021, this changed to 2 weeks later. In 2021, the requirement for the Hib vaccination was removed. A recurring issue during the audit process was a lack of documentation in patient discharge summaries. Whilst there are a proportion of patients who have not received their post-splenectomy vaccinations, it is reassuring to note that none of these patients had subsequent admissions to hospital with overwhelming infections based on their CHARTs records. We have created a proforma that can be brought up on CHARTs during follow up appointments for documentation of compliance with vaccinations. GPs can be easily contacted about missing vaccinations. We also recommended that all discharge paperwork have clear documentation of when vaccinations should be administered and that a re-audit should be done in 2023.

The Impact of Standardized Infectious Diseases Consultation on Postsplenectomy Care and Outcomes.

BackgroundPatients who receive splenectomy are at risk for overwhelming postsplenectomy infection (OPSI). Guidelines recommend that adult asplenic patients receive a complement of vaccinations, education on the risks of OPSI, and on-demand antibiotics. However, prior literature suggests that a majority of patients who have had a splenectomy receive incomplete asplenic patient care and thus remain at increased risk. This study assessed the impact of standardized involvement of infectious diseases (ID) providers on asplenic patient care outcomes in patients undergoing splenectomy.MethodsA quasi-experimental study design compared a prospective cohort of patients undergoing splenectomy from August 2017 to June 2021 who received standardized ID involvement in care of the asplenic patient with a historic control cohort of patients undergoing splenectomy at the same institution from January 2010 through July 2017 who did not. There were 11 components of asplenic patient care defined as primary outcomes. Secondary outcomes included the occurrence of OPSI, death, and death from OPSI.ResultsFifty patients were included in the prospective intervention cohort and 128 in the historic control cohort. There were significant improvements in 9 of the 11 primary outcomes in the intervention arm as compared with the historic controls. Survival analysis showed no statistically significant difference in the incidence of OPSI-free survival between the groups (P = .056), though there was a trend toward improvement in the prospective intervention arm.ConclusionsStandardized involvement of an ID provider in the care of patients undergoing splenectomy improves asplenic patient care outcomes. Routine involvement of ID in this setting may be warranted.

Super-Selective Partial Splenic Embolization for Hereditary Spherocytosis in Children: A Single-Center Retrospective Study.

BackgroundHereditary spherocytosis (HS) is the most common hemolytic anemia due to erythrocyte membrane defects. Total splenectomy is the most effective treatment for moderate or severe HS. As a conservative alternative, partial splenic embolization (PSE) can preserve part of the spleen's function, thus reducing the risk of overwhelming post-splenectomy infection (OPSI) or sepsis, especially for pediatric patients. However, it is not easy to precisely control the scope of interventional embolization, limiting PSE applications. The present study aims to optimize the PSE procedure on smaller, which is named super-selective PSE (SPSE), to improve the controllability and assess the feasibility and effectiveness of SPSE.ResultsThis study was conducted by retrospectively reviewing clinical data from HS patients treated by surgical treatments, which were diagnosed at the children's hospital of Chongqing medical university from January 2015 to December 2019. Patients were divided into two groups according to their treatment preference: SPSE (16 patients) group and total splenectomy (41 patients) group. The mean proportion range of splenic embolism by SPSE was 82.4%, close to the expected value (70–85%). The average hemoglobin value was increased significantly from 6.85 (5.6–8.0) g/dl before SPSE to 12.4 (10.4–13.3) g/dl after SPSE (p < 0.001). All children after SPSE suffered mild post-embolization syndrome, such as pain, fever, and vomiting, which could easily be controlled with appropriate supportive therapy.ConclusionsSuper-selective partial splenic embolization is a safe and effective treatment for moderate or severe HS in children. However, with a longer follow-up, more patients further assess the value of SPSE.

Splenectomy Results in Venous Thromboembolic Events in Women: A Nurses Health Study

Background:Splenectomy is a therapy for many conditions the most common of which are trauma, Hodgkin lymphoma, thalassemia and hereditary or autoimmune hemolytic anemia, and immune thrombocytopenia (ITP). By 1960 splenectomy had been known to create a risk of over-whelming post splenectomy sepsis (OPSS) with a high mortality rate. More recently population-based studies from Denmark have suggested that there is also an increased risk of thromboembolic (TEE) complications. Thromboembolic events generally include venous thrombosis (deep vein thrombosis (DVT) and pulmonary embolism (PE)) and arterial thrombosis (stroke and myocardial infarction [MI]). ITP and hemolytic anemias have been shown to independently have increased risks of arterial and venous TEE which has complicated assessment of additive effects of splenectomy. While splenectomized patients appear to be at increased risk of arterial and venous thromboses, the incidence and which TEEs predominate remains unclear as does the timing of occurrence of the TEEs.Method:The Nurses' Health Study (NHS) was established in 1976 and enrolled 121,700 female nurses between 30-55 years old. The nurses completed baseline questionnaires and biennial follow up questionnaires. In 2004, NHS participants were asked whether they had undergone splenectomy. The primary outcomes of this study included DVT,PE, and MI, which were identified through self-report on biennial questionnaires. MIs were confirmed through medical record review. End of follow-up for this study went through 2016, date of death, or diagnosis of outcome, whichever came first. Loss to follow up was very low and causes of deaths were carefully tracked.Descriptive statistics compared the splenectomy vs non-splenectomy participants with respect to basic demographic factors and variables that may be related to the outcomes. Cox proportional hazards models were run to evaluate incidence rates for primary and secondary outcomes. We conducted age-adjusted, as well as multivariable adjusted models. Multivariate models were adjusted for age, body mass index, smoking history, diabetes mellitus, high blood pressure, and high cholesterol, thus taking into account known predictors of the specific TEEs. Multivariate models were updated every two years to account for time varying confounders.Results：In 2004, 323 participants reported having had a splenectomy, out of 96,000 completing the questionnaire. There was a strong, significant association between splenectomy and subsequent DVT (n=613) and PE (n=840). The multivariate adjusted HR was 3.73 (95%CI: 1.77-7.86) and 3.80 (95%CI: 2.04-7.10) respectively. When considered together as a composite outcome, the splenectomized participants had a 3.52-fold higher risk (95%CI: 2.12-5.85) of PE/DVT compared with non-splenectomy. There was no association between splenectomy and MI (n=1011; HR = 0.97, 95% CI: 0.31-3.01). Given the very limited number of stroke cases in the splenectomized population, we were underpowered/unable to evaluate the association of splenectomy and subsequent risk of stroke.Conclusion:This study found that splenectomized patients are at a 4-fold increased risk of PE and DVT as compared to not-splenectomized individuals. These findings were not dependent on any of the potentially confounding variable analyzed. We found no association between splenectomy and MI. There are limitations to these results. No information was available on family history and perioperative thrombo-prophylaxis. Also we do not know exactly when or why splenectomy was performed; there were at least 34 women who had splenectomy for ITP but in most cases the underlying disease was unknown. Since the nurses in 1976 were already between 30-55 years old, it is no longer possible to retrospectively obtain sufficient information. Therefore, the splenectomy question has been added to the current survey for NHS#2. We will pursue the relevant information in a follow up letter to respondents who reported having undergone splenectomy while seeing if the findings of NHS#2 confirm those of NHS#1. [Display omitted] DisclosuresBussel: Principia/Sanofi: Consultancy, Membership on an entity's Board of Directors or advisory committees; UCB: Consultancy, Membership on an entity's Board of Directors or advisory committees, Other: DSMB; Momenta/Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Argenx: Consultancy, Membership on an entity's Board of Directors or advisory committees; Dova/Sobi: Consultancy, Membership on an entity's Board of Directors or advisory committees; CSL: Other: DSMB; RallyBio: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees; Amgen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Rigel: Consultancy, Membership on an entity's Board of Directors or advisory committees; UptoDate: Honoraria.

＜Editors' Choice＞ Long-term outcomes of the partial splenectomy for hypersplenism after portoenterostomy of patients with biliary atresia.

ABSTRACTMassive splenomegaly and hypersplenism in patients with biliary atresia after Kasai portoenterostomy were treated with partial splenic embolization or total splenectomy. We performed partial splenectomy to reduce the complications of partial splenic embolization and avoid overwhelming post-splenectomy infection. This study aimed to evaluate the long-term effects of partial splenectomy for hypersplenism on postoperative liver and spleen function in patients with biliary atresia. Among jaundice-free patients with biliary atresia who underwent Kasai portoenterostomy between January 1992 and December 2012, 15 underwent partial splenectomy for massive splenomegaly and hypersplenism at our institution. Changes in the laboratory data 10 years post partial splenectomy were retrospectively investigated, and these along with the latest data were measured. A total of four patients (27%) required living-donor liver transplantation after partial splenectomy, a proportion similar to those who did not undergo partial splenectomy. Compared to the preoperative baseline, the platelet counts were significantly higher at 1 and 3 years after surgery (p < 0.05). Aspartic aminotransferase-to-platelet ratio index was significantly lower at 1, 7, and 10 years after partial splenectomy (p < 0.05). No further surgeries were required for hypersplenism after partial splenectomy over 10 years, and there were no cases of overwhelming post-splenectomy infection after partial splenectomy. Partial splenectomy is safe and effective for the treatment of hypersplenism with biliary atresia over a long time period. It could be considered as an alternative to partial splenic embolization as it can suppress hypersplenism for a long time and induces fewer postoperative complications.

SPLENECTOMY IN PAEDIATRIC AGE GROUP

Background: In view of splenectomy in dealing with certain clinical problems in paediatric age group. Objective: To describe the profile, indications, post-operative management and outcomes of children undergoing splenectomy. Methods: All children undergoing splenectomy from June’2019 till August’2021 at INDEX MEDICAL COLLEGE, INDORE, M.P. Results: The mean age at surgery was 9.9 years (range 3-16). Most splenectomies were per-formed for haematological disorders and were open .The mean post-operative length of stay (LOS) in patients who underwent open surgery was 4 days. No cases of overwhelming post splenectomy infec-tion (OPSI) were noted. At study completion, haematological disorders were the most common indication for splenectomy in children. Conclusion: Indications for paediatric splenectomy mirror those found in international litera-ture. We haven't performed splenectomy, laparoscopically. Within this short span of time, no mortal-ity was recorded. We did not have any case of OPSI. Key words: splenectomy

Clinical review of splenic trauma in central India: a prospective observational study

Background: Spleen is one of the most commonly injured intra-abdominal solid organs. If undiagnosed in earlier stage patient may even present with shock. Even though management depend on grade on splenic injury, primary goal remains stabilizing the patient. The operative interventions are done by open or laparoscopic technique which may be splenorrhaphy or splenectomy.Methods: A prospective observational study on 52 patients with splenic injury was performed. The study period was 27 months. Patients with clinical and radiological signs of splenic trauma were categorised and operative/ non-operative treatment was given as per protocol. The surgical and nonsurgical outcomes were evaluated during inpatient stay and follow-up was kept.Results: Fifty-Two patients were analysed comprising 36 male and 16 females. Most common mode of injury was road traffic accident followed by falls. Grade III injury was commonest, while rib fracture was commonest associated injury. Pneumonia was a frequent complication postoperatively.Conclusions: Splenic injury is a real threat after blunt abdominal trauma in young population. Vaccination and equalae of OPSI (Overwhelming post splenectomy infection) must be kept always in mind after splenectomy. Splenic trauma diagnosed early and treated immediately can save the patient’s life.

Overwhelming postsplenectomy infection during treatment for malignancy

Overwhelming postsplenectomy infection during treatment for malignancy

Splenic preservation versus splenectomy during laparoscopic distal pancreatectomy for benign and low-grade malignant pancreatic tumor: A propensity score matching analysis

Previous studies showed the advantages of spleen preservation during laparoscopic distal pancreatectomy (LDP) such as preventing overwhelming postsplenectomy infection, and early infectious complications, maintaining immune surveillance, less postoperative pancreatic fistula, less postpancreatectomy diabetes, and less gastric ileus. However, there were limitations of these results such as heterogenous population, and small number of patients. This study was aimed to compare clinical outcomes of patients with LDP with splenectomy (LDPS) and laparoscopic spleen preserving distal pancreatectomy (LSDP) using propensity score matching analysis from data of multi centers in Korea and Japan. The patients were identified who underwent LDPS and LSDP in Korea and Japan. Perioperative outcomes including postoperative infectious complication were compared between LDPS and LSDP before and after PSM. Matching variables were used such as nation, age, sex, BMI, ASA scores, underlying disease, previous abdominal surgery, preoperative pancreatitis, malignant disease and tumor locations. LDPS and LSDP were classified in 1,728 (39.6%), and 2,635 (60.4%), respectively. In the mean age and body mass index were 56.3 and 23.4. And 1,166 (26.7%) patients underwent previous abdominal surgery and tumor was located in body and tail in 2,041 (46.8%) and 2,290 (52.5%), respectively. Pancreas was transected at pancreas neck and tail level in 1,794 (41.1%) and 2,521 (57.8%), respectively. Splenic vessels were preserved in 1,244 (28.5%) of 2,635 patients with LSDP. Two hundred patients (4.6%) experienced conversion to open during surgery. Of patients, 1,303 (29.9%) patients experienced postoperative complications. Clinically related postoperative pancreatic fistula (CR-POPF) and infectious complication rates were 693 (15.3%) and 760 (17.4%) patients, respectively. After PSM, 1,594 patients were selected in each group. The patients with LSDP showed comparable overall complication (35.7 % vs. 38.4 %, p = 0.094), however LSDP group showed lower infectious complications (15.2 % vs. 19.1 %, p = 0.036), CR-POPF (13.7 % vs. 18.7 %, p < 0.001), infected POPF (5.7 % vs. 9.7 %, p < 0.001), complicated fluid collection (0.94% vs. 2.82%, p < 0.001) compared with the patients with LDP. The results of this study showed that LSDP was related with lower infectious complication rate including lower infected POPF, and lower complicated fluid collection compared with LDPS, and this result is helpful to decide splenic preservation in patients who needs LDP for pancreatic body or tail lesions.