To compare clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) in cirrhotic patients with a history of partial splenic embolization (PSE) vs splenectomy, focusing on shunt patency, overt hepatic encephalopathy (OHE), rebleeding, and survival. This retrospective study included 240 cirrhotic patients undergoing TIPS (TIPS + PSE: n = 126; TIPS + splenectomy: n = 114). After propensity score matching, 88 patients per group were analyzed. The primary endpoint was shunt dysfunction; secondary endpoints included OHE, rebleeding, and survival. TIPS + PSE group had lower rates of shunt dysfunction (10.2% vs 30.7%, p < 0.001) and OHE (17.1% vs 39.8%, p < 0.001) than TIPS+splenectomy. No differences were found in rebleeding or survival (p > 0.05). Cox regression showed the treatment group (PSE vs splenectomy) as an independent predictor of shunt dysfunction (HR = 3.24, 95% CI: 1.56-6.91, p = 0.002) and OHE (HR = 1.96, 95% CI: 1.03-3.74, p = 0.042). Portal vein thrombosis was identified as an independent predictor of shunt dysfunction (HR = 2.47, 95% CI: 1.16-5.27, p = 0.019). Age (HR = 1.04, 95% CI: 1.00-1.08, p = 0.046) and Model for end-stage liver disease score (HR = 1.20, 95% CI: 1.02-1.41, p = 0.027) were independent predictors of mortality. Among patients undergoing TIPS, those with prior PSE had a more favorable outcome regarding shunt dysfunction and OHE than those with prior splenectomy, with comparable rebleeding and survival. These findings support prioritizing PSE over splenectomy for patients who may later require TIPS. Question The influence of prior splenic intervention on outcomes after TIPS in cirrhotic patients with portal hypertension remains uncertain, particularly regarding the comparative effects of PSE vs splenectomy. Finding Among patients undergoing TIPS, those with prior PSE had a more favorable outcome regarding shunt dysfunction and OHE than those with prior splenectomy, with comparable rebleeding and survival. Clinical relevance TIPS after PSE offers better outcomes in reducing shunt dysfunction and overt OHE in cirrhotic patients with portal hypertension, supporting prioritizing PSE over splenectomy for patients who may later require TIPS.

Abstract Hydatid disease is a parasitic infection caused by Echinococcus granulosus and remains an important health problem in endemic regions. Although the liver and lungs are the most frequently affected organs in children, multisystem involvement is relatively rare, especially in immunocompetent individuals. Here we present a case with multisystem hydatid disease, A 30-month-old immunocompetent female presented with intermittent high-grade fever and productive cough for one month. Chest radiograph revealed a thick-walled cystic lesion in the right upper lung zone. Subsequent imaging demonstrated additional cystic lesions in the liver and spleen, consistent with disseminated hydatid disease. The patient underwent partial splenectomy and hepatic cyst enucleation, followed by right upper lobectomy as the cyst had severely destroyed the infected lung tissue. In this case, we aimed to present the clinical symptoms, radiological findings, and type of surgery performed in a child with multisystem hydatid cyst. This case highlights the occurrence of multiple organ hydatid disease in an immunocompetent child. Multisystem involvement, although rare, should be considered in endemic regions, and prompt diagnosis with appropriate multidisciplinary management is essential for favorable outcomes.

Laparoscopic partial splenectomy (LPS) is the preferred spleen-preserving approach for benign lesions, avoiding the risks of total splenectomy. However, the technique remains technically demanding, particularly for large cysts extending to the splenic hilum. We present a case highlighting the technical nuances of selective vascular control and the management of a significant, delayed complication. A 22-year-old female presented with chronic left upper quadrant pain. CT imaging revealed a 50x70 mm epidermoid cyst at the lower pole, extending to the splenic hilum. She underwent an LPS. This case demonstrates that selective vascular ligation is a feasible technique for hilar lesions. However, it also serves as a crucial reminder that significant complications can occur in a delayed fashion, well after the initial discharge. LPS for large epidermoid cysts extending to the hilum is technically feasible. Key lessons include: [1] meticulous hilar dissection with selective vessel ligation provides excellent vascular control, [2] this approach maximizes parenchymal preservation, and [3] clinicians must maintain a high index of suspicion for delayed complications, such as symptomatic pleural effusion, which may require intervention

Objective: To evaluate the safety and efficacy of using small and ultra-small sized grafts for in situ auxiliary liver transplantation in the treatment of portal hypertension. Methods: A prospective single-arm cohort study was conducted. Patients who underwent liver transplantation at Beijing Friendship Hospital from December 2014 to July 2025 were included. Intraoperative portal vein pressure was routinely monitored, with the target regulation for portal vein blood flow set at<15 mmHg (1 mmHg=0.133 kPa) and follow-up continued until September 2025. The primary endpoints were the patient's status and graft survival. The secondary endpoints were small-for-size syndrome and perioperative complications. The small-for-size syndrome was graded according to the 2023 International Liver Transplantation Society consensus statement. Results: A total of 33 cases were enrolled. Among them, 22 had ultra-small size grafts, 11 had small-size grafts, 28 had living donor grafts, and five had split grafts. The graft-to-recipient weight ratio in living donor liver transplantation was 0.31%～0.79%, while in split liver transplantation it was 0.45%～1.02%. Intraoperative portal vein pressure of ≥15 mmHg was observed in 11 cases, who underwent portal vein blood flow adjustment via splenic artery ligation (2 cases), partial splenectomy (8 cases), and/or restrictive portocaval shunting (1 case), after which all patients achieved the target portal vein pressure. All cases completed at least one month of follow-up, with 28 cases following for more than one year, and the median follow-up period was 36.5 months. Early-stage postoperative small-for-size syndrome occurred in eight cases (24.2%, 8/33), all classified as grade A, with improvements following supportive treatment. Severe complications (Clavien-Dindo≥Ⅲ) occurred in three cases (9.1%, 3/33). The one-year survival rate was 92.9% (26/28). The overall survival rate at the end of follow-up was 90.9% (30/33). No patients experienced graft loss or death due to small-for-size syndrome. Graft tissue tested negative for hepatitis B core antibody and covalently closed circular DNA, and hepatitis B surface antigen seroconversion was achieved following second-stage residual liver resection and under a combined strategy of potent nucleos(t)ide analogs and hepatitis B immunoglobulin in ten cases of hepatitis B-related disease. Conclusions: With standardized portal vein blood flow monitoring and individualized portal vein blood flow adjustment, in situ auxiliary liver transplantation can safely and effectively use small and even ultra-small sized grafts, thereby significantly expanding graft sources and ensuring donor and recipient safety. These findings warrant further validation and promotion in multicenter controlled studies.

Rationale:Pancreatic lymphoepithelial cyst (PLEC) is a rare benign pancreatic cystic lesion that poses considerable diagnostic challenges owing to its overlapping clinical and imaging features with malignant neoplasms. Misdiagnosis frequently results in unnecessary surgical interventions. This case report aims to elucidate specific clinical and radiological characteristics essential for the accurate diagnosis of PLEC.Patient concerns:A male patient presented with abdominal pain. Laboratory tests revealed elevated serum carbohydrate antigen 19-9 (CA19-9) levels. An abdominal computed tomography (CT) scan identified a cystic mass in the head and body of the pancreas.Diagnoses:The patient underwent a partial pancreatectomy and splenectomy, followed by histopathological biopsy, which confirmed the diagnosis of PLEC.Interventions:Following postoperative PLEC diagnosis, the patient was placed under regular surveillance, including abdominal CT scans and serum CA19-9 monitoring.Outcomes:The patient underwent partial pancreatectomy and splenectomy without complications. Abdominal pain completely resolved by postoperative day 18. By day 30 of follow-up, CA19-9 levels had decreased to 9 U/L. Subsequent evaluations at 6 months, including abdominal CT and tumor marker assessments, confirmed sustained remission without evidence of recurrence, indicating an excellent clinical outcome.Lessons:PLEC, a rare benign lesion, often mimics malignancy, potentially leading to unnecessary radical surgeries. Diagnostic hallmarks include its tendency to present as an exophytic cystic mass in middle-aged men; CT features demonstrating cyst fluid density exceeding that of simple or mucinous cysts with thin, mildly enhancing walls; and pathognomonic magnetic resonance imaging findings of T2-hyperintense subcapsular nodules exhibiting restricted diffusion in a noninfiltrative, wall-apposed pattern without ductal communication. Markedly elevated CA19-9 levels should not preclude PLEC. When this constellation of features is present, PLEC should be considered in the differential diagnosis.

Primary lesions of the spleen are very rare, and splenic lymphatic malformations (SLMs) account for 0.007% of all splenic lesions; thus, SLMs are often ignored in clinical practice. The aim of this study was to review the clinical and imaging features of 35 patients with SLMs, classify them on imaging and provide a reference for treatment. We reviewed the records of patients with SLMs who entered the medical system at our institution from December 2008 to March 2023. The clinical characteristics and imaging features of these patients were collected to classify SLMs. In our case series, 82.9% (29/35) of the patients with SLMs were adults, whereas only 6 patients were children, and 97.1% of (34/35) patients were women. A total of 68.6% (24/35) of the patients were asymptomatic. Seven patients experienced complications, such as cyst rupture, cyst bleeding, and mass effects. On imaging, the average cyst diameter of the SLMs was 5.2cm, and macrocystic SLMs (23/35) were the most common. SLMs can be divided into isolated SLMs, multiple SLMs, and diffuse SLMs, of which 17 cases were isolated lesions, 14 cases were multiple lesions, and 4 cases were diffuse lesions. Some lesions were accompanied by cyst wall calcification. All patients underwent surgical removal, and no signs of recurrence were found during the 5-year postoperative follow-up. SLMs are uncommon with insidious onset, and most patients are asymptomatic; however, complications still exist. Partial splenectomy is an option for isolated SLMs, whereas total splenectomy is necessary for diffuse SLMs.

Abstract A 3‐year‐old male neutered Collie was presented with gastrointestinal signs, lethargy and weight loss, following a history of pancreatitis. Computed tomography revealed large, coalescing nodules in both the pancreas and spleen, and abdominal effusion. Analysis of effusion revealed degenerative neutrophils with intracellular bacteria. The patient underwent exploratory laparotomy. Partial pancreatectomy, splenectomy and drain placement were performed successfully. Post‐operative management included antibiotics, drain management, fluid therapy and supportive care. Gram staining of pancreatic tissue revealed clusters and short chains of Gram‐positive cocci; however, bacterial cultures of the peritoneal fluid and pancreatic tissue were negative. Histopathological examination confirmed severe suppurative acute pancreatitis with extensive interstitial fibrosis and vascular abnormalities in the spleen and pancreas. The dog recovered well from surgery and was alive at the time of publication with no evidence of recurrence.

The treatment of benign splenic diseases is trending toward a conservative approach, especially for young patients, due to the importance of preserving as much splenic parenchyma as possible. Minimally invasive partial splenectomy (PS), which has become the gold standard for managing benign splenic conditions, is generally associated with low morbidity and near-zero mortality. Herein, we describe a standardized and safe technique to perform this procedure. This new approach combines preoperative selective distal embolization of the splenic artery with indocyanine green (ICG)-guided robotic partial splenectomy using the technique of negative staining as applied in liver surgery.

The dilemma of current treatments for symptomatic patients with portal hypertension is how to resolve the problems of the varices and hypersplenism simultaneously and meanwhile preserve the splenic function. Partial splenectomy and pericardial devascularization is a potential alternative to currently used approaches, but it is incompletely defined. This study aimed to evaluate the efficacy and safety of partial splenectomy and pericardial devascularization. This study followed 132 symptomatic patients with portal hypertension who underwent partial splenectomy and pericardial devascularization in the General Surgery Department of the Fifth Medical Center of PLA General Hospital from 2016 to 2023. Clinical, laboratory, endoscopic examination and imaging data were collected and compared between preoperative and postoperative levels at intervals using a mixed linear model. All 132 patients with portal hypertension successfully underwent partial splenectomy and pericardial devascularization without intraoperative uncontrolled massive bleeding or death. Leucocyte and platelet counts increased to normal levels at intervals from 1 year to ≥ 4 years postoperatively. Among the patients followed for six months postoperatively, 23 (52.27%) showed improvement in esophagogastric varices, 19 (43.18%) had no significant changes in their condition, and 2 (4.55%) experienced worsening of the varices. At subsequent follow-ups, the majority of patients either showed improvements or no change in their esophagogastric varices, with only a small fraction experiencing worsening of the condition. The splenic remnant survived in most patients, and regrowth was very limited postoperatively, while 13 (9.85%) patients splenic remnant necrosis during follow-up. Liver failure was observed in 5 (3.79%) patients postoperatively, and 3 (2.27%) of them died perioperatively. Portal vein thrombosis was found in 90 (75%) patients the 7th days after surgery. With the progression of follow-up time, the proportion of patients with postoperative portal vein system thrombosis decreased over time. 3 (2.27%) patients experienced postoperative abdominal bleeding, which improved after emergency surgery for hemostasis. Partial Splenectomy and Pericardial Devascularization appears to be a safe and effective approach to treat symptomatic patients with Portal Hypertension, while preserving the potential function of the spleen.

Laparoscopic partial splenectomy (LPS) is an effective method for resecting benign splenic lesions while maintaining physiological splenic function.1,2 The primary surgical challenge is controlling hemorrhage during parenchymal transection. Although previous studies have highlighted the success of bipolar electrothermal devices, and microwave ablation in this phase,3-5 we introduced a novel technique integrating ultrasonic dissection with linear stapling technology. This approach occludes major intraparenchymal vasculature during transection, improving both safety and efficiency. A 66-year-old female patient with a 7.3 cm cyst in the upper pole of the spleen underwent preoperative evaluation with computed tomography (CT) and magnetic resonance imaging (MRI). Our LPS protocol proceeded as follows: (1) splenic ligament and short gastric vessels are divided using hemlock clips, (2) anatomical identification of segmental vessels supplying the upper pole, (3) parenchymal pre-dissection along ischemic demarcation line, and (4) combined use of ultrasonic dissection and sequential stapling for parenchymal transection. The procedure was completed in 145 min with minimal blood loss (50 mL). No intraoperative complications or blood transfusions were required. The patient was discharged on the fourth postoperative day without complications. Pathological examination confirmed the complete removal of a benign mesothelial cyst. The stapler-assisted LPS technique enhances the safety and efficiency of LPS by minimizing intraoperative hemorrhage and streamlining the parenchymal transection process.

BackgroundThe spleen is also the largest lymphoid organ and has important immune and haematopoietic functions. Traumatic splenic rupture often results in haemorrhagic shock and is life-threatening. In the past, total splenectomy was performed for various degrees of splenic injury, which caused great harm to the patient. Over the past few decades, the treatment of blunt splenic injury has also changed significantly, from total splenectomy to a focus on procedures that preserve splenic function. At the same time, the use of splenic artery embolization in high-grade splenic injuries has also reduced the failure rate of non-surgical treatment and the incidence of conversion to open splenectomy.MethodsAccording to the American Association for the Surgery of Trauma (AAST) spleen injury grading, this study selected 80 patients treated in our emergency department for blunt splenic injuries of grade II–III between 1 January 2023 and 1 January 2025. These patients were the study subjects (40 patients received partial splenic artery embolization (intervention group) and 40 patients received splenectomy (control group)). The clinical therapeutic outcomes of the two treatment approaches were analysed by SPSS.ResultsIn contrast to the control group, patients in the intervention group exhibited reduced operation time, time to first flatus, time to removal of drainage tubes and hospitalization time. Furthermore, the incidence of surgical complications was found to be lower in the intervention group than in the control group. The T lymphocyte CD4 + /CD8 values of the intervention group were higher than those in the control group at 2 and 4 weeks postoperatively, and the difference was statistically significant (P < 0.05).ConclusionPartial splenic artery embolization has obvious advantages in the treatment of grade II–III blunt splenic injuries, and provides data support and reference significance for the selection of treatment methods for low-grade blunt splenic injuries.Trial registration: This study is a statistical analysis of relevant data for patients who have received a medical intervention and therefore does not involve trial registration.

Long-Term Outcome After Partial Splenectomy Compared to Total Splenectomy in Children With Spherocytosis.

BackgroundThe indications for laparoscopic partial splenectomy (LPS) in pediatric benign splenic tumors are well established, but concerns remain regarding its technical complexity and potential complications. This study aimed to evaluate the safety and outcomes of single-incision LPS (SILPS).MethodsA retrospective analysis was conducted on 22 children who underwent SILPS from July 2021 to April 2024, compared with 25 patients who received laparoscopic total splenectomy (TS). Clinical characteristics, operative details, and postoperative outcomes were assessed.ResultsSILPS patients had comparable operative time, blood loss, and hospital stay to those in the TS group. However, SILPS was associated with significantly lower rates of postoperative thrombocytosis and leukocytosis. No major perioperative complications were observed.ConclusionSILPS is a safe and effective spleen-preserving technique for pediatric benign splenic tumors, offering reduced hematologic complications without increasing surgical risks. It is technically demanding and requires experienced laparoscopic skills and proper patient selection.

A 10-year-old girl was admitted to our hospital for treatment of recurrent melena and severe anemia. Her treatment history comprised Kasai's portoenterostomy for biliary atresia as an infant, followed by liver transplantation and partial splenectomy for portal hypertension at 1year old. Her medications comprised steroids, immunosuppressive agents, a β-blocker, and a potassium-competitive acid blocker. Since the age of 5years, she had repeatedly visited a local hospital for melena, but the bleeding source had not been identified. She was referred to our hospital, and laboratory data revealed severe anemia. An enhanced computed tomography showed post-liver transplantation status, splenomegaly, and gastric varices, without extravasation. Esophagogastroduodenoscopy and colonoscopy did not identify the bleeding source. Double-balloon endoscopy (DBE) revealed variceal bleeding and serosanguinous fluid accumulated at the choledochojejunostomy site in the jejunum. After obtaining informed consent, our team and the radiologists cooperatively performed DBE-assisted endoscopic injection sclerotherapy with 75% n-butyl-2-cyanoacrylate through a 23- gage needle according to high-resolution varicerography in a hybrid emergency room. Subsequently, the patient was discharged and regularly monitored without any complications. We demonstrated the first pediatric case of successful DBE-assisted endoscopic injection for hemorrhagic jejunal varices after liver transplantation for biliary atresia and partial splenectomy.

Management of Splenic Vascular Anomalies: A Review of 17 Pediatric Cases at a Single Institution.

Hereditary microspherocytosis (HM) is an inherited hemolytic anemia associated with erythrocyte membrane abnormalities which should be suspected in patients with a triad of symptoms: anemia, jaundice, and splenomegaly. The distinct clinical manifestations may not appear until a certain age, resulting in many undiagnosed mild-to-moderate forms of HM. Although modern technology allows to detect genetic mutations for HM confirmation, many issues remain largely unresolved and need to be addressed. The aim: to analyze a complex clinical case of HM in a child with a long-term diagnostic stage to raise awareness among physicians about this pathology. The clinical case of a 17-year-old boy with a clinical diagnosis of “Hereditary microspherocytosis, crisis course, complicated by secondary chronic calculous cholecystitis” was discussed. Clinical and paraclinical findings were analyzed. The medical case describes HM in the boy who presented with the first symptoms of anemia at the age of 3 years, and manifestations of jaundice syndrome with hyperbilirubinemia, hepatomegaly debuted only at the age of 12 years. Such features of the disease course have translated to diagnostic delay of HM and the development of calculous cholecystitis as a complication. Conclusions. Currently, mild forms of hereditary microspherocytosis are underdiagnosed. Mild and moderately severe course of hereditary microspherocytosis, apart from jaundice and moderate splenomegaly, can be manifested by cutoff hemoglobin values, making it difficult to timely diagnose primary disease and its complications. Since the most common complication of hereditary microspherocytosis is gallstone disease, regular ultrasound examinations of the gallbladder and monitoring of the hepatobiliary system are the best imaging modalities for patients even in the absence of overt hemolysis. In case of conservative therapy ineffectiveness, it is necessary to consider the issue of performing a complete or partial splenectomy, and in the presence of a complication in the form of calculous cholecystitis, it should be combined with cholecystectomy. The analyzed clinical case is a demonstrative example of underdiagnosed mild hereditary microspherocytosis complicated by secondary chronic calculous cholecystitis. The research was carried out in accordance with the principles of the Declaration of Helsinki. The informed consent of the patients was obtained for the study. The authors have no conflicts of interest to declare.

Although gastrointestinal stromal tumors (GISTs) are rare tumors of the gastrointestinal tract, they are the most common mesenchymal tumors of the gastrointestinal tract. The majority of these tumors occur in the stomach, but they could be found anywhere along the gastrointestinal tract. A 72-year-old man presented with a large intra-abdominal mass. A Tru cut biopsy revealed features of a GIST. He underwent a resection of the intra-abdominal mass along with a partial gastrectomy and splenectomy. His postoperative course was uneventful.

Correlation of Genetic Mutation With Outcomes in Children With Hereditary Spherocytosis Undergoing Partial Splenectomy: AMulticentre Study.

BackgroundTraumatic splenic rupture is a life-threatening acute abdominal condition. While traditional total splenectomy effectively controls bleeding, it results in the loss of splenic function, increasing the risk of infectious complications and long-term health issues. Laparoscopic partial splenectomy, as a minimally invasive spleen-preserving approach, offers a new treatment option for such patients. However, its technical complexity limits its clinical adoption, requiring further experience accumulation and technical optimization.MethodsThis study retrospectively analyzed the clinical data of 13 patients with traumatic splenic rupture treated between 2018 and 2021 to evaluate the safety, efficacy, and applicability of laparoscopic partial splenectomy. All patients were diagnosed via contrast-enhanced abdominal CT imaging. During surgery, partial splenectomy was performed using splenic artery occlusion combined with anatomical dissection. Perioperative data and postoperative changes in blood parameters were recorded.ResultsThe median operative time was 120 min, with a median intraoperative blood loss of 1,500 mL. The residual spleen in all 13 patients maintained good blood supply. Blood tests showed a gradual resolution of postoperative inflammatory responses, with platelet levels returning to normal. Imaging follow-up confirmed improved blood supply to the residual spleen. The median postoperative hospital stay was 14 days, and all patients survived and preserved splenic tissue. One patient developed a minor splenic infarction that resolved, and no patient experienced re-bleeding, overwhelming infection, or other major complications.ConclusionsLaparoscopic partial splenectomy demonstrates favorable safety and efficacy in patients with traumatic splenic rupture. By optimizing intraoperative vascular control and careful management of the resection site, this procedure not only preserves partial splenic function but also reduces postoperative complications. It provides a reliable minimally invasive surgical option for the treatment of traumatic splenic rupture.

Portal hypertension and bleeding esophageal varices caused by portal vein thrombosis in children: experience of a single center with emphasis on treatments and results