Splenic Disorders Research Articles

SHOBHANJANA (MORINGA OLEIFERA LAM.) FLOWER: A PHARMACOLOGICAL REVIEW

Moringa oleifera Lam. is, plant of the Moringaceae family, which is also known as drumstick tree, miracle tree due to its miraculous effects. It contains various macronutrients and micronutrients such as vitamins. It contains Bioactive Plant Compounds such as flavonoids, tannins, phenolic acids, sterols, etc. which directly or indirectly affects the organism consuming it. Moringa oleifera flowers possess antioxidant, anti-cancerous, anti-inflammatory, anti-microbial, chemo-protective activity. Along with its hepatoprotective action, it is used in splenic disorders also. Ayurveda mentions the Moringa oleifera Lam. in the treatment of various diseases such as Gulma, Arbuda (tumors) due to its intensive penetrative properties, in Vidradhi (abscess), in eye diseases, etc. It is well known Ayurveda drug for its capacity to act as mucolytic, fat metabolizer, aphrodisiac and cell nutri-tive. It lowers Vata and Kapha dosha, and lessens worms, edema, and abscesses. Moringa oleifera is able to treat obesity, lymphadenitis, tumors, thyroid enlargement and ulcers/wounds. Moringa oleifera flowers are in-cluded under Pushpa shaka. Bhavprakash emphasised the benefits of Moringa flowers for treating worm infesta-tions, splenic disorders, abscesses, Kapha and Vata conditions, and inflammation of the tendons, etc. In recent studies, Moringa oleifera Lam. flower extracts have shown cell proliferation activity in rat fibroblasts, MSCs and angiogenesis.

Point Shear Wave Elastography for Splenic Assessment: A Comparative Study of Splenomegaly and Normal Spleens.

Background The spleen, a key immunological organ, plays a crucial role in filtering aged or damaged red blood cells. Splenomegaly, an enlargement of the spleen, can arise from a variety of physiological and pathological conditions, including hematological disorders, hepatic diseases, and infections. Accurate diagnosis and evaluation of splenomegaly are essential for effective treatment. Objectives The objective of this study was to evaluate splenic stiffness in patients with splenomegaly using point shear wave elastography (pSWE) and compare the findings with those of individuals with normal spleen. Materials and methods This hospital-based observational study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India, from October 2022 to December 2023. The study included 56 participants, divided into two groups: 28 patients with splenomegaly and 28 healthy controls. Spleen stiffness was measured using a Samsung HS70A ultrasound machine (Samsung Electronics Pvt. Ltd., Seoul, South Korea), and pSWE was performed with a curvilinear probe. Data were analyzed using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States), and the significance of differences was assessed using an independent t-test with a p-value of <0.05, considered statistically significant. Results The mean spleen stiffness, measured in kilopascals (kPa), was significantly higher in individuals with splenomegaly (32.05 ± 12.54 kPa) compared to controls (22.9 ± 9.49 kPa) (p = 0.003). A positive correlation (rho = 0.482, p < 0.001) was observed between spleen diameter and spleen stiffness. Conclusion This study demonstrates that pSWE is an effective, non-invasive tool for assessing spleen stiffness. The higher spleen stiffness in splenomegaly patients underscores pSWE's diagnostic utility, with a positive correlation between spleen diameter and stiffness. Further multi-center studies are recommended to validate these findings, highlighting pSWE's promise in evaluating and monitoring splenic disorders.

Laparoscopic Splenectomy as A Result of Morbid Consequences in The Treatment of Benign Splenic Disorders and Malignant Splenic Diseases

Laparoscopic Splenectomy as A Result of Morbid Consequences in The Treatment of Benign Splenic Disorders and Malignant Splenic Diseases

HPTLC Fingerprinting Profile of Root of Punarnava (Boerhaavia diffusa Linn.)

Introduction: The root of Punarnava (Boerhaavia diffusa Linn.) possesses high therapeutic value and is used in many conditions such as Gulma (abdominal tumor), Pandu (anemia), Yakrit roga (liver disorders), Pleeha roga (splenic disorders), and Hridroga (cardiac disorders). But, before internal administration, it is essential to confirm the drug’s authenticity and quality. Obtaining authentic chromatographic fingerprints that accurately reflect the pharmacologically active and chemically distinctive components of the drugs is essential. High-performance thin-layer chromatography (HPTLC) fingerprinting helps to know the authenticity and identity of the drug. It is highly useful to avoid the unnecessary usage of adulterated drugs. Detection of the marker compound is essential to know the mechanism of action a drug in particular diseases and systems of the body. Materials and Methods: In the present study, methanolic extract of root powder of B. diffusa Linn. was selected. Solvent system used was toluene, ethyl acetate, and formic acid (5:4:0.5). After development, the plate was examined under ultraviolet light 254 nm, 366 nm, and after derivatization in white light. Results and Discussion: While analyzing the HPTLC fingerprinting profile of Punarnava (B. diffusa Linn.), at 254 nm, it showed six peaks and at 366 nm, it showed ten peaks. At 254 nm, highest peak was obtained at Rf 0.03 with a total area of 4390.5 (AU). At 366 nm, highest peak obtained at Rf 0.02 with a total area of 7211.2 (AU). Conclusion: For identification of medicinal plants, the HPTLC fingerprinting profile is a crucial component of the standardization of herbal drugs. At 254 nm, it shows 6 peaks and at 366 nm, it shows 10 peaks.

Overview on Dravaka Kalpana w.s.r. to Shankha Dravaka

Rasashastra is the Iatrochemistry of Ayurveda which deals with formulations containing herbals, minerals and metals. Various Kalpanas are mentioned in Rasashastra such as Pottali Kalpana, Kharaliya Kalpana, Parpati Kalpana. Dravaka Kalpana is one among them which is made out of predominately “Lavana- Kshara” Dravyas. Dravaka Kalpana is a liquid dosage form that is prepared either by using Agni or without the use of Agni. Shankha Dravaka is one such Dravaka Kalpana that is mentioned in the different classical texts. It is indicated in various diseases such as Gulma (abdominal lump), Shoola (pain), Yakrit Dosha (disorders of the Liver), Pliha (splenic disorders), Ashmari (calculus) etc. It is used in less dosage by diluting with water. Different Acharyas have mentioned different methods of its preparation. This article compiles review of Ayurvedic literature on Shankha Dravaka. This literature review is carried out to create the base for undertaking future research work because without research efficacy, the utility cannot be established

Assessment of Anatomical and Histological Changes in Splenomegaly Due to Liver Cirrhosis by Use of Sharpunkha: An Experimental Study

Splenomegaly is the disease commonly affecting normal anatomy and histology of spleen. It remains undetectable and worsens as the time passes and person suffers from stressful life. It leads as a consequence of many diseases. One of them important disease is Liver cirrhosis. In Ayurveda also relation of liver and spleen is depicted emphatically. Yakrita and Pleeha are described as Moolsthana of Raktvaha Strotasa and site of Raktadhara Kala and which are the important aspects of Ayurvedic Rachana Sharir. The facts regarding liver cirrhosis and splenomegaly are very much serious which has provoked us to think about to detail study of splenomegaly due to liver cirrhosis. There is no absolute treatment of splenomegaly till date. In Bhavprakasha, there is reference regarding Sharpunkha (Tephrosia Purpurea)that it is “Pleehashatru” showing that it might acts on the spleen and cures splenic disorders. But there is evidence base gap regarding efficacy of Sharpunkha on Splenomegaly. Kshara or Churna of Sharpunkha Panchanga are described as its useful preparations. There is no work done till date showing action of Sharpunkha Panchanga Kshara or Churna on Splenomegaly and there is deficit of study showing alteration in anatomy and histology of spleen affecting due to splenomegaly by using Sharpunkha. So it is needed to study effect of both Kshara and Churna separately and compare them so that we can use Panchanga Kshara or Panchanga Churna with more specificity. It can be a new modality in the field of Ayurvedic science to study effect of Sharpunkha Panchanga Kshara and Panchanga Churna on Splenomegaly showing changes in anatomy and histology of spleen affecting due to splenomegaly. Also with the help of that “Pleehghan Prabahva” and classical assert as “Pleehashatru” of Sharpunkha can be proven.

A Cadaveric Study on Morphometric Features of Spleen and Splenomegaly with Accessory Spleen in Hilum

Background: Anatomical knowledge regarding the external morphology of the spleen is essential for surgical intervention and radiological diagnosis. Splenomegaly is defined as pathologic enlargement of the spleen measured by size or weight. A normal spleen has a craniocaudal length of no more than 12 cm and weighs less than 200 g. It is surrounded by a thin capsule. The spleen is usually not palpable unless it is enlarged; therefore, a palpable spleen is almost always abnormal. At times the spleen may be difficult to palpate, but dullness to percussion during inspiration in the area of the lower left intercostal space in the left anterior axillary line suggests splenic enlargement. Massive splenomegaly, weight &gt;1000 g usually occurs in lymphoma, myeloproliferative disorders, visceral leishmaniasis, and malaria. Materials and Methods: This study was conducted in different medical institutions, to find morphometric features, spenomegaly in cadaver during routine anatomy dissection as part of curriculum, 100 cadavers were observed to find out splenomegaly. Results: Out of 100 spleens studied, 81 cases wedge shaped spleen was the most common, followed by 12 tetrahedral shaped spleens and 7 oval shaped spleens. Average weight of the spleen was 175g. Average length of the spleen was 11.64cm, Average breadth of the spleen was 7.3cm and average thickness of spleen was 3.6cm. Out of 100 cadavers observed only one cadaver observed with massive splenomegaly with one accessory spleen in hilum. The spleen weight was 875gm, length was 18.15 cm, width was 8.65cm, thickness was 5.75cm and extended upto 7 rib and it is easily palpable below the rib cage from lumbar aspect. The cadaver was male and age around 55 years. Conclusion: The morphometric knowledge of spleen will helpful for surgeons and for understanding deceases related spleen. The knowledge of splenomegaly is important in finding splenic disorders and accessory spleen information helpful in understanding embryonic development of spleen. KEY WORDS: Splenomegaly, Spleen, Hilum of Spleen, Accessory spleen.

Senescence-associated secretory phenotype and activation of NF-κB in splenocytes of old mice exposed to irradiation at a young age

DNA damage-induced cellular senescence is involved in aging. We reported previously that p53+/− mice subjected to irradiation at a young age exhibited an increased number of splenic lymphocytes in the S and G2/M phases. However, the detailed nature of splenic disorders in these mice is not fully understood. In this study, we investigated the effects on molecules in splenocytes, especially on senescence factors after early exposure of mice to radiation. Mice, 8- (young) or 17-, 30-, and 41-week-old (old) p53+/− were subjected to 3-Gy whole-body irradiation. Splenocytes were prepared at 56 weeks of age. Immunoblot showed that irradiation at 8 weeks enhanced the expression and phosphorylation of p53, cyclin-dependent kinase 2, cell division cycle 6, and the MDM2 proto-oncogene in splenocytes. However, these molecules were not affected by irradiation at 17, 30, and 41 weeks of age. Similarly, irradiation at 8, but not 17, 30, or 41 weeks, induced phosphorylation of IKKα, NF-κB inhibitor alpha, and p65. Electrophoretic mobility shift assay demonstrated that active forms of NF-κB were increased. In addition, enzyme-linked immunosorbent assay showed that lipopolysaccharide-induced IL-6 production was enhanced in splenocytes of mice irradiated at 8 weeks. ATP levels were increased in splenocytes of mice irradiated at 8, but not 17, 30, or 41 weeks. CDK2 expression and p65 phosphorylation were induced in CD45R/B220+ cells from irradiated mice. Overall, irradiation induced a NF-κB-related immune response in the spleen with an increase in senescence marker proteins, such as CDKs and IL-6, which are known to be typical senescence-associated secretory phenotype factors related to stresses, such as DNA damage.

Evaluation of the outcomes of laparoscopic splenectomy in non-traumatic pathological splenic disorders

Background: currently,minimal invasive surgical techniques were used for several operations in general surgery. Less intra-operative blood loss,less post-operative pain and shorter hospital stay results are some of the benefits that make laparoscopy the best approach for many surgical procedures.Therefore, laparoscopic splenectomy since 1991 when was first described by Delaitre and Maignien. In general, indications for laparoscopic splenectomy are the same as those of open splenectomy, except for the trauma cases, where the role of laparoscopy is still debatable. The introduction of advanced laparoscopic tools for ligation, dissection and vessels sealing devices resulted in less operative time and less intra-operative complications. However, some contraindications still applied, more studies are needed to determine the real value of laparoscopy in massive splenomegaly. Objectives:The aim of the work is evaluation of the outcomes, safety and efficacy of laparoscopic splenectomy in non-traumatic splenic disorders. Patients and methods: This prospective study conducted on patients with hematological disorders indicated for splenectomy for one year. Results: We operated 20 patients of laparoscopic splenectomy, 70% were females, their mean of age by years were 18.9 ± 9.1. No post-operative complications the mean of operation time byhours was3.2 ± 0.7, while the mean of hospital stay was 2.3 ± 0.2 days. The total intra-operative blood loss was about 50–600 ml. Conclusion: Laparoscopic splenectomy for elective operations of the spleen is a safe method associated with a lower risk of peri-operative complications,less mortality and morbidity.

A Case Report Wandering Spleen in a Young Primiparous Woman Treated by Laparoscopic Splenectomy: A Case Report

Background: Wandering spleen (WS) is an uncommon splenic disorder defined as the displacement of the spleen from its usual anatomical position. It is most prevalent in females in their reproductive age. It can be encountered incidentally or may present with symptoms. Risks of complications exist and vary with the presentation. Several imaging techniques are able to define it clearly preoperatively. Laparoscopic surgery is the definitive diagnostic and therapeutic method. Case Report: A 24-year-old pregnant female patient presented to the Emergency Department complaining of intermittent dull abdominal pain and pelvic heaviness for 9 days. Contrast- Enhanced Computed Tomography and a color Doppler sonography of the abdomen and pelvis showed a large-sized spleen in the pelvis corresponding to a diagnosis of WS, without ischemic signs. The patient underwent a laparoscopic splenectomy and was vaccinated for Haemophilus influenza, meningococcus, and pneumococcus postoperatively. The post-operative period was uneventful, and the patient later delivered a full-term baby girl by a Cesarean section. Conclusion: This is, to the best of our knowledge, the second reported case of laparoscopic splenectomy in a pregnant patient with WS. While splenopexy is associated with better outcomes, splenectomy seems to be preferred in pregnant patients, who may undergo a vaginal delivery, but guidelines and data are still scarce regarding the management of WS in pregnancy. Vaccination against encapsulated bacteria is required in case of splenectomy

An Overlooked Entities in Small Animal Surgery: Splenic Disorders

An Overlooked Entities in Small Animal Surgery: Splenic Disorders

Ultrasonographic Characterization of Spleen and Liver in Clinically Healthy Camels

This study aimed to investigate the ultrasonographic position and characteristic appearance of spleen and liver in adult camels. The spleen was visualized on the left side from 9th to12th ICS. Many small sized echoes occupied uniform space were the characteristic constituent of splenic parenchyma and vessels seen as elongated or round to oval anechoic views within the parenchyma. The splenic dorsal margin and extent were largest at 9th ICS (66.75±1.47 and 17.1±1.01 cm) and smallest at 12th ICS (41.8±1.31 and 10±0.74 cm), respectively. The mean diameter of vessels of the spleen ranged from 0.21±0.03 to 0.4±0.01 cm. For the liver, it was scanned from the right side between 9th to 11th ICS. The shortest hepatic dorsal and ventral margins (37.07 ± 1.07 and 54.37 ± 1.76 cm) were found at 11th ICS, but cranially became greater to 9th ICS (43.84 ± 1.82 cm and 61.58 ± 1.17), respectively. The greatest hepatic extent was at 9th ICS (17.72 ± 1.68). The normal hepatic parenchyma was composed of large numbers of weak echoes evenly spread through the liver. We concluded that, the splenic and hepatic assessment by ultrasonography could provide an essential reference guide for diagnosing splenic and hepatic disorders in camels.

Ultrasonography of the pediatric spleen: a pictorial essay.

In infants and children, the spleen is involved in many pathological processes, whether those processes are isolated or related to systemic diseases. Pathology of the pediatric spleen includes congenital anomalies, splenomegaly, trauma, focal lesions, infarction, and tumors. Ultrasonography (US) is a widely available, fast, noninvasive imaging technique to assess the size, shape, and position of the spleen, as well as to define splenic echotexture. US is capable of screening for splenic disorders without the risk of ionizing radiation; it is the initial imaging examination performed to evaluate suspected splenic pathology, providing clinicians with helpful decisional support. US plays an important role in the detection of even very small amounts of hemoperitoneum, a herald of significant abdominal organ injury, in pediatric blunt abdominal trauma. Moreover, contrast-enhanced US may allow early detection of splenic injuries, ideally minimizing children's risk from radiation exposure. This pictorial essay illustrates the normal ultrasound appearance of the pediatric spleen and the sonographic findings which may guide clinicians to a correct diagnosis of pathologic conditions.

Sickle Cell Disease in Newborns in Germany: Analysis of the AOK Health Insurance Data

Sickle cell disease (SCD, ICD-10:D57) is a hemoglobinopathy of global public health relevance. As an autosomal recessive genetic disorder, it affects 70-150 newborns in Germany per year (1-2 per 10,000). Early detection during the asymptomatic first 3 months of life would meet national treatment recommendations and prevent disease sequelae. Objectives are 1) to measure the prevalence of SCD in newborns in the AOK's claims data, 2) to determine the age at first diagnosis D57, and 3) to count typical hospitalizations. Inpatient and outpatient data on 204 children born in 2009 and 2010, insured with the AOK for at least one day in their year of birth and coded as D57 during 6 calendar years were analyzed. The number of newborns in the AOK in 2009 and 2010 (denominator) is known. Valid SCD cases (numerator) fulfilled the requirement for D57 (except D57.3) to be coded at least 2 times in different quarters of years. The prevalence proportion (PP) was calculated with a bootstrapped confidence interval (CI). The first mention of D57 per case was dated in quarters of years (Q). The Standardized Incidence Ratio (SIR) was calculated to compare hospitalizations from the month 13 to month 61 with the age- and sex-matched population (1-4-year olds). The calculations were performed with SPSS 22 and Excel. The validation resulted in 78 SCD cases. The prevalence was 1.96 (95% CI 1.53-2.41) per 10,000 newborns. Regions of higher prevalence were Berlin, Bremen and Hamburg (summarized) and North Rhine-Westphalia. In only 15.4% of the cases, D57 was mentioned early (in Q1-2). The median date was in Q7. There were 266 hospitalizations in relation to 78 children, with an SIR=6.8. The rate of hospitalizations was thus 6.8 times higher than in the population. Feared outcomes such as pneumonia, septicemia and splenic disorders were among the hospital discharge diagnoses. SCD in Germany is evident in claims data of Germany's largest statutory health insurance. At present, the opportunity for early detection is being widely missed. The time to diagnosis could be shortened by the inclusion of SCD in the universal newborn screening. Until this policy is implemented, parents with a relevant family background and health professionals should pay more attention to SCD.

Spleen and splenic vascular involvement in acute pancreatitis: an MRI study.

To investigate the spleen and splenic vascular involvement in acute pancreatitis (AP) and their correlations with the severity of AP using magnetic resonance imaging (MRI). MRI of 239 patients with AP was retrospectively reviewed to assess splenic and splenic vascular complications, and the severity of AP. The severity of AP was graded by the MRI severity index (MRSI) and the New Revised Classification of AP 2012. The intravoxel incoherent motion (IVIM) parameters (D, D*, and f) of spleen were measured. Thirty-five subjects without pancreatic and splenic disorders were enrolled as controls for IVIM parameters. Among the 239 patients with AP, splenomegaly (16.7%), splenic infarction (0.4%), splenic vein thrombosis (4.2%), phlebitis (7.5%) and arteritis (4.2%) were observed. Splenic vascular involvement was positively correlated with the severity of AP based on both the MRSI and the New Revised Classification of AP 2012 (P<0.05). In the control and AP groups, the splenic f values were (0.164±0.074) vs. (0.210±0.095) (P=0.023) respectively. In AP patients with and without splenomegaly, f = (0.240±0.091) vs. (0.203±0.095) (P<0.001). Splenic vascular involvement and splenomegaly were common in AP. The vascular involvement was associated with the severity of AP. This complication should be considered when severity and prognosis of AP are assessed. Quantitative analysis of the spleen with IVIM might be a useful imaging biomarker for splenic perfusion changes in AP, especially in those with splenomegaly.

Echographie Pédiatrique En Pratique Hospitaliere Au Centre Hospitalier Universitaire (CHU) De Kara Au Togo

Purpose: To list pediatric ultrasound exams performed at Kara University Hospital Center in Togo and the pathologies observed. Materials and methods: This was a retrospective and descriptive study of the results of pediatric ultrasound examinations performed in the Department of Radiology and Imaging of Kara University Hospital Center. The study ran from January 1, 2013 to December 31, 2016, over a period of 3 years. Results: The frequency of pediatric ultrasounds was 5.1%. The average age of the patients was 2.16 years with extremes of 1 day to 15 years. There was a male predominance with a sex ratio of 1.4. Abdomino-pelvic ultrasound were the most represented, 92%, followed by cervical ultrasound in 2.6% of cases. Abdominal ultrasound indications were dominated by abdominal pain in 33.6% of cases, followed by palpation of abdominal mass in 15.7%. Cervical ultrasounds were motivated in 5 out of 8 cases by the cervical swelling. Abdomino-pelvic ultrasonography was pathological in 70.1% of cases. Hepatic affections were the most common abdominal abnormality in 37.8% of cases followed by splenic disorders. Hepatic lesions were dominated by European Scientific Journal February 2018 edition Vol.14, No.6 ISSN: 1857 – 7881 (Print) e - ISSN 1857- 7431 444 homogeneous hepatomegaly with 63.2% of cases. Cervical ultrasound was pathological in 6 out of 8 cases. The lesions observed were mainly cervical lymphadenopathy (4 cases out of 6). Conclusion: Ultrasound is a very useful tool in the exploration of pediatric diseases. The abdominal ultrasound is the most performed and hepatic pathologies are the most common.

Sonographic Measurement of Spleen in Relation to Age: A Prospective Study among Adult Nepalese People in Western Nepal

Introduction: Splenomegaly is an enlargement of the spleen which is a quite common problem in any part of the world. Spleen is enlarged in various clinical disorders e.g. infections, metabolism or storage disor­ders and hematological abnormalities. Splenomegaly is an indicator of pathologic process that may be of primary splenic origin but also may be a reflection of disease in virtually any other organ system. Thus, it is important to estimate the splenic size in vivo in the diagnosis, treat­ment and prognosis of a variety of disorders.Objective: The objective of this study was to determine the normal dimension of the spleen in the adult Nepalese people.Methods: This is a prospective study in which 320 adults subjects were scanned by using 3.5 MHz curvilinear probe. We used ultrasonography to examine 160 males and 160 females, not to have any condition likely to be associated with splenic enlargement. The measurement for the length and thickness of spleen were obtained in right lateral position.Results: This study revealed the splenic dimensions for males were greater than in females. The men spleen length were (10.07 ±0.7 cm, 10.1 ±0.54 cm, 9.5 ±0.7 cm and 9.0 ±0.43 cm for age group of 16 - 30, 31 - 45, 46 - 60 and 61 - 75 years respectively). The females spleen length were (9.83 ±0.53 cm, 9.58 ±0.58cm, 9.2 ±0.64 cm and 8.8 ±0.36 cm for age group of 16 - 30, 31 - 45, 46 - 60 and 61 - 75 years respec­tively). The men spleen thickness were more (4.1 ±0.5 cm, 4.05 ±0.58 cm, 3.43 ±0.38 cm and 3.0 ±0.36 cm for age group of 16 - 30, 31 - 45, 46 - 60 and 61 - 75 years respectively). The females splenic thickness were 4.06 ±0.47 cm, 3.78 ±0.48 cm, 3.38 ±0.35 cm and 2.29 ±0.23 cm for age group of 16 - 30, 31 - 45, 46 - 60 and 61 - 75 years respectively. Thus significant differences between male and female splenic dimen­sions were found for each age group chosen (P &lt;0.05).Conclusions: The results show that the splenic length and thickness decreased with increase in age in both males and females and all the di­mensions were greater in males than in females. This study established normogram that can be more reliably used as both a complementary modality to clinical evaluation and as a more sensitive means of evalu­ating and screening patients for splenic disorders for any pathologi­cal enlargement or reduction of size in clinical practice in a Nepalese populations.Journal of Gandaki Medical College Vol. 10, No. 1, 2017, page: 11-16

Single-Port Laparoscopic Splenectomy as an Alternative for Conventional Laparoscopic Splenectomy

Introduction: Laparoscopic splenectomy is developing as the gold standard for the management of splenic disorder. The concept of minimal-invasive surgical techniques has progressed since the early 1990s from the standard multiport laparoscopy to the natural orifice transluminal endoscopic surgery and recently, to single-port laparoscopic surgery. Aim: To assess the feasibility and safety of transumbilical single port laparoscopic splenectomy. Patients and methods: Between September 2013 and August 2016, transumbilical single-port splenectomy was performed on 13 patients via a 2.5 cm curved incision at the lower umbilicus edge, and special single incision laparoscopic surgery (SILS™) port (Covidien, Mansfield, MA) was introduced through which splenectomy was done. Results: A total of fifteen patients underwent minimally invasive splenectomy. There were 3 conversions to multiport laparoscopic splenectomy. The operative time was (123.07±16.7). Conclusion: Single port laparoscopic splenectomy is safe and feasible and could be a logical alternative to classical laparoscopic splenectomy.

Hemostasis Technique Using an Adjustable Nylon Tie in Dog with Splenic Hematoma and Lymphoid Hyperplasia

Background: Splenic hematoma is an encapsulated blood accumulation, which is macroscopically indistinguishable from malignant spleen. The treatment of choice and final diagnosis were by splenectomy and exploratory laparotomy followed by biopsy and histopathological examination, respectively. Nylon tie bands are devices made of polyamide 6.6, same material of surgical nylon wires, and has been used in different surgical procedures in animals. The present report case aimed to describe the use of nylon tie bands polyamide 6.6 in a 2.3-year-old Golden retriever dog diagnosed with splenic hematoma and lymphoid hyperplasia; and the clinical presentation, diagnostic evaluation, histological diagnosis of splenic hematoma and lymphoid hyperplasia.Case: A 2.3-year-old intact male Golden retriever dog was presented with history of anorexia, apathy, regurgitation and weight loss. During the physical examination was identified a mass in the left side of abdomen. The complete blood count (CBC), serum biochemistry, urinalysis, and thoracic radiographs were no alteration. Abdominal ultrasound revealed splenomegaly and heterogeneous hypoechoic structure. Splenectomy using an adjustable nylon ties polyamide 6.6 for hemostasis technique was performed during an exploratory laparotomy. The spleen presented hematoma and lymphoid hyperplasia at the histopathological examination, as well as the presence of siderocalcinotic plate in the trabecular spleen. The dog presented with no regurgitation, apathy or anorexia after 10 days of surgery. CBC, serum biochemistry analysis, thoracic radiographs and abdominal ultrasound revealed no abnormalities. Video laparoscopy did not showed any sign of adherence on the local where used the nylon tie bands. One year and three months after the surgery, the owner was contacted by telephone, since he had changed to other city, and he reported that the dog was healthy without any clinical signs.Discussion: The present case report describes the using of nylon tie polyamide 6.6 bands in a 2.3-year-old Golden retriever dog diagnosed with splenic hematoma and lymphoid hyperplasia. According to the author’s knowledge, the present case is the first report regarding to using nylon tie bands in splenectomy, and clinical characteristics of hematoma and lymphoid hyperplasia in young dog. The adjustable nylon tie bands allowed a secure and faster ligature when compared with traditional nylon surgical suture wires in different surgical procedures in animals and humans patients, and was considered well tolerated and non-toxic. Reports concerning to complications to the use of nylon tie in veterinary surgery were present in the literature. Otherwise, these complications were related to surgical technique failure and inadequate aseptic technique; inadequate use of nylon tie bands before assigning it as a hemostatic material. Partial splenectomy is recommended for treatment of splenic hematoma and lymphoid hyperplasia in dogs whenever possible; however, the macroscopic findings concerning splenic disorders are not enough to set the distinction between benign and malignant disorders. Clinical sign associated with splenic disorders in the present case was abdominal distension due to hematoma and nodular lymphoid hyperplasia. An adjustable nylon tie polyamide 6.6 band can be used to clamp the spleen vessels, gastroepiploic artery, gastric artery and omento veins.

Early Experience with Laparoscopic Splenectomy in Benign Splenic Disorders

Background: Laparoscopic splenectomy is evolving procedure and is now considered the procedure of choice in elective splenectomy by many centers, but technically demanding especially in large sized ones. Our aim was to evaluate the outcome of laparoscopic splenectomy for a variety of benign splenic disorders in our early experience. Patients and Methods: This prospective study was carried out on twenty-two patients treated with laparoscopic splenectomy in Tanta University Hospital from January 2014 to January 2016. Patients chart review including patient characteristics, splenic pathology, intraoperative difficulties or complications and postoperative outcome. Follow up ranged from 6 months to 2 years with a mean of 20 months. Results: Age of patients ranged from fifteen to fifty-nine years with a mean of 41.7 years. Fourteen cases (63%) with idiopathic thrombocytopenic purpura (ITP), six cases (27.3%) with hypersplenism and two cases (9.1%) with autoimmune hemolytic anemia. Accessory spleens were found in six patients (27.3%) and removed. Mean operative time was 120±15 minutes. Intraoperative bleeding occurred in six cases (27.3%), laparoscopic control attempted and succeeded in four of them, but conversion was inevitable in two cases (9.1%). There were no major postoperative complications or deaths. Conclusion: Laparoscopic splenectomy is not only safe minimal invasive procedure, with comparable results of the open splenectomy in management of small and medium sized spleens but also, has the advantages of negligible intraoperative blood loss. Larger series with longer periods of follow up are required to evaluate this promising operation.