Splenic Pathologies Research Articles

Splenectomy indications and postoperative follow-up results of a department of general surgery

Aim: Splenectomy is commonly performed in many centers around the world for the treatment of various benign, malign diseases and trauma nowadays. The purpose of this study is to determine the indications in patients undergoing splenectomy in a general surgery department for five years and to investigate the mortality rate and reasons. Material and Methods: Data of the study were obtained retrospectively by scanning records of patients over the age of 18 who underwent open splenectomy in the general surgery department between December2012 and December2017. Demographic data, duration of hospitalization, distribution of emergency and elective operations, main reasons and indications of splenectomy, operation components, histopathological results, the survey of patients and mortality rate were investigated. Results: 55,4% (n=31) female, 44,6% male, total 56 patients were included in the study. The mean age of the patients was 50.5±22,6. The mean duration of hospitalization was 9±7 days. 71.4%of the patients were operated under elective conditions and 28.6%of the patients were operated under urgent conditions. Splenectomy was done for the reason of carcinoma in 34.2% of patients, traumatic splenic injury in 19.4%, splenic cyst or abscess in 16.2%, coagulopathy in 12.6%, iatrogenic splenic injury in 5.4%, lymphoma in 3.6%, splenomegaly associated with portal hypertension in 3.6%, fibrosarcoma in 1.8%, idiopathic splenomegaly in 1.8%. Conclusion: Splenectomy is performed in general surgery departments due to traumatic and non-traumatic indications. Mortality due to pure splenic pathologies is uncommon and quite rare. However, mortality caused by other operations and diseases in patients who underwent splenectomy is quite high.

Combined Laparoscopic–Endoscopic Technique for Gastric Diverticulectomy

Purpose: Gastric diverticula are rare manifestations of diverticular disease, accounting for 3% of all diverticula. Methods: We present the case of a 17-year-old male who presented with complaints of epigastric fullness, reflux, and early satiety. He was given a trial of proton pump inhibitors with minimal improvement. A contrast swallow study showed an irregularity at the gastric fundus. A gastric diverticulum was confirmed on endoscopy and the patient was referred to surgery. Resection was planned because of symptomatology. Utilizing laparoscopic–endoscopic rendezvous technique, the posterior lying diverticulum was resected. A nasogastric tube was placed postoperatively and the patient was kept nil per os for 24 hours. He was advanced to a diet and discharged home on postoperative day 3. At follow-up he has no complaints. Results: Gastric diverticula are uncommon manifestations of diverticular disease. These lesions have equal incidence in males and females and occur in pediatric patients only rarely, 4%. Gastric diverticula may be congenital or acquired. Congenital gastric diverticula are true diverticula, occurring posteriorly within 2–3 cm of the gastroesophageal junction and are thought to arise from a defect in the gastric wall musculature. Patients with congenital diverticula are often asymptomatic or present with vague abdominal complaints, thought to be because of their location and broad base. Emergency complications include bowel obstruction, perforation, or bleeding. Oral contrast swallow studies and upper endoscopy provide the most reliable diagnosis; however, many patients will undergo CT or ultra sound imaging because of their vague complaints, and these lesions are often confused for splenic, adrenal, or pancreatic pathologies. Conclusion: Gastric diverticula are rare congenital abnormalities in pediatric populations. Resection is recommended for resolution of symptoms. A laparoscopic–endoscopic rendezvous procedure allows for adequate identification and observation of the lesion. No competing financial interests exist. Runtime of video: 3 mins 16 secs A version of this video was previously presented at the American College of Surgeons Meeting in Washington DC, October 19, 2016.

Common and uncommon features of focal splenic lesions on contrast-enhanced ultrasound: a pictorial review.

The characterization of focal splenic lesions by ultrasound can be quite challenging. The recent introduction of contrast-enhanced ultrasound (CEUS) has come to play a valuable role in the field of imaging splenic pathologies, offering the possibility of an ionizing radiation-free investigation. Because CEUS has been incorporated into everyday clinical practice, malignant diseases such as focal lymphomatous infiltration, metastatic deposits, benign cysts, traumatic fractures, and hemangiomas can now be accurately depicted and characterized without the need for further imaging. More specifically, splenic traumatic fractures do not require additional imaging by computed tomography (with ionizing radiation exposure) for follow-up, because splenic fractures and their complications are safely imaged with CEUS. In the new era of CEUS, more patients benefit from radiation-free investigation of splenic pathologies with high diagnostic accuracy.

Splenic infarction as a pitfall on labeled red blood cell imaging

Patient with a history of overt gastrointestinal bleeding, diabetes mellitus, hypertension, polycythemia vera, and choledocojejunostomy was hospitalized because of hematemesis and melena. An area of Technetium-99m labeled red blood cells accumulation at the splenic flexure similar to an overt bleeding area, was observed on gastrointestinal bleeding scintigraphy (GIBS). In case of underlying malignancy, abdominal computed tomography was performed and demonstrated the infarction area placed laterally in spleen, appearing as a cold region on sctintigraphic image, separating the inferomedial and upper part of splenic uptake. Splenic variants and pathologies can complicate interpretation of GIBS.

Ultrasonography of the spleen. Pictorial essay

Contrast-enhanced ultrasound is widely indicated in the study of splenic diseases, especially due to its good specificity in the differentiation of benign from malignant splenic lesions. The purpose of this pictorial essay is to offer a review of the most common splenic pathologies, while illustrating them with sonographic images.

Multimodality imaging of splenic lesions and the role of non-vascular, image-guided intervention

Splenic lesions are often incidentally detected on abdominal-computed tomography (CT), ultrasound, or magnetic resonance imaging (MRI), and these can pose a diagnostic challenge in patients with suspected or known malignancy. This review will discuss the multimodality imaging features of various benign and malignant splenic pathologies including trauma, infection, infarct, granulomatous disease, benign neoplasms such as hemangioma, hamartoma, and littoral cell angioma, cystic entities such as peliosis, splenic cysts, and pseudocysts, and malignant processes such as metastasis, lymphoma, angiosarcoma, and leiomyosarcoma. While several of these splenic pathologies have characteristic imaging features that are helpful in diagnosis, others have nonspecific findings. In such clinical dilemmas, image-guided intervention may be essential, and we therefore discuss the role of non-vascular, image-guided splenic interventions for diagnostic and therapeutic purposes. The radiologist can play a key part in the clinical diagnosis and management of splenic lesions, and therefore a thorough knowledge of the imaging features of splenic lesions and a thoughtful approach to their management is crucial.

Sonographic evaluation of accessory spleen

SUMMARY Objective: Accessory spleens (AS) usually appear on routine abdominal ultrasonography (US) and frequently not investigated. The aim of this study is to research the prevalence, imaging features and related conditions of AS. Materials and Methods: This study is based on 190 patients that applied to US department with various clinical symptoms in 18 months period. Patient ages, gender; although AS counts, location, shape, dimension and probable accompanied splenomegaly researched on B-mode US. Results: Majority of AS had a dimension between 10-15 mm. Usually they are round shaped and localized at splenic hilus. They mostly visualized in female with the mean age 32.9 (SD: 19.2). There was no statistically difference between splenomegaly and dimension of AS. Positive significant correlation was found between not only age and dimension (p<0.05, r=0.305), but also gender and splenomegaly (p<0.05), dimension and shape (p<0.05). Conclusion: Sonographic features of AS are investigated. This report reveals sonographic findings of AS, that may be used on differential diagnosis of splenic pathologies.

Computed tomography of the spleen: how to interpret the hypodense lesion

BackgroundAs the largest single lymphatic organ in the human body, the spleen is responsible for central immunological and haematological tasks. Therefore, the spleen can be subject to a wide range of pathologic disorders. Computed tomography (CT) represents the most widely applied cross-sectional abdominal imaging technique and is considered the imaging modality of choice for the evaluation of numerous abdominal pathological conditions. Hypodense splenic lesions are frequently encountered on abdominal CT images. Although most hypodense lesions of the spleen can be considered benign, some findings and clinical conditions warrant closer attention to the lesion. CT offers a number of morphological criteria that can be applied to differentiate hypodense lesions of the spleen, such as a the appearance of a lesion’s borders, its attenuation, as well as the presence of calcifications or solid components.MethodsThis article reviews the most common splenic pathologies leading to hypodense appearances on CT images and illustrates the key CT imaging findings in the context of the clinical history of the patients.ConclusionThe key imaging findings of hypodense splenic lesions are presented in order to aid interpretation during routine evaluation of abdominal CT images.Teaching Points• Haemangiomas, congenital in origin, represent the most common benign lesions of the spleen. • Lymphoma represents the most common malignant tumour of the, usually secondarily involved, spleen. • Most hypodense splenic lesions on CT represent benign lesions that require no further work-up. • For correct interpretation, hypodense splenic lesions need to be evaluated in the clinical context.

Laparoscopic splenectomy for splenic hamartoma: a case report.

Hamartoma is a rare splenic benign tumor usually accidentally detected as a radiologic finding. Preoperative diagnosis poses a challenge and thus surgery becomes necessary to confirm the clinical suspicion. Laparoscopic splenectomy has gained consensus as a standard surgical procedure particularly for autoimmune hematological diseases. This former experience has allowed this technique to be extended to other splenic pathologies. Here we report a case of total laparoscopic splenectomy for a bulky splenic hamartoma in a young male patient.

Autopsy findings in a human immunodeficiency virus-infected population over 2 decades: influences of gender, ethnicity, risk factors, and time.

To examine autopsy pathology in an urban population infected with the human immunodeficiency virus (HIV) and to determine if age at death and disease frequencies are associated with gender, HIV risk factors, ethnicity, and therapeutic era. Retrospective analysis of autopsy data from 394 HIV-infected adults. The population was divided into 3 therapeutic eras for analysis: group A, 1979-1986; group B, 1987-1995; and group C, 1996-2000. Women died at significantly younger ages than men (mean +/- SEM age, 38.9 +/- 1.0 years vs 42.5 +/- 0.64 years), even after adjustment for risk factors, ethnicity, and therapeutic era. This age discrepancy occurred despite a lower prevalence of arteriosclerosis, cachexia, and hepatitis B in women and no significant differences in the frequencies of other infectious diseases. Whites had a longer survival than patients of other ethnicities (mean age at death, 44.7 +/- 1.2 years for whites, 39.9 +/- 0.80 years for blacks, and 41.3 +/- 0.87 years for Hispanic individuals). Renal, cardiac, and splenic pathologies, Mycobacterium avium-intracellulare (MAI) infection, and cachexia were more common in blacks than in whites and/or Hispanic individuals, and cytomegalovirus and systemic lymphoma were more common in whites and Hispanic individuals than in blacks. Diseases associated with intravenous drug use were hepatitis C, cirrhosis, and tuberculosis; those with all sexual risk factors, cytomegalovirus infection, herpes simplex virus infection, and Pneumocystis carinii pneumonia; and those with homosexual risk, Kaposi sarcoma and MAI infection. The prevalence of many disease entities changed over time: compared with the other groups, group C had lower prevalences of many viral and fungal illnesses, MAI infection, systemic lymphoma, cachexia, and Kaposi sarcoma and higher prevalences of hepatitis, cirrhosis, arteriosclerosis, staphylococcal and streptococcal infections, and traumatic lesions. When the data were adjusted for changing demographic and risk composition, the only significant changes in disease frequency for period C were decreased prevalences of PCP and Kaposi sarcoma and increased prevalences of cirrhosis and arteriosclerosis. Significant gender- and ethnicity-related differences in age of death occurred in this HIV-infected population, and these differences were not explained by the frequencies of diseases. The lower prevalences of PCP and Kaposi sarcoma in group C are likely a reflection of the impact of potent therapies on causes of mortality. The higher prevalences of cirrhosis and arteriosclerosis suggest that entities not targeted by antiretroviral reconstitution of immunity will play an increasingly important role in HIV-related mortality in the future.

Autopsy findings in a human immunodeficiency virus-infected population over 2 decades: Influences of gender, ethnicity, risk factors, and time

Objectives To examine autopsy pathology in an urban population infected with the human immunodeficiency virus (HIV) and to determine if age at death and disease frequencies are associated with gender, HIV risk factors, ethnicity, and therapeutic era. Design and methods Retrospective analysis of autopsy data from 394 HIV-infected adults. The population was divided into 3 therapeutic eras for analysis: group A, 1979-1986; group B, 1987-1995; and group C, 1996-2000. Results Women died at significantly younger ages than men (mean +/- SEM age, 38.9 +/- 1.0 years vs 42.5 +/- 0.64 years), even after adjustment for risk factors, ethnicity, and therapeutic era. This age discrepancy occurred despite a lower prevalence of arteriosclerosis, cachexia, and hepatitis B in women and no significant differences in the frequencies of other infectious diseases. Whites had a longer survival than patients of other ethnicities (mean age at death, 44.7 +/- 1.2 years for whites, 39.9 +/- 0.80 years for blacks, and 41.3 +/- 0.87 years for Hispanic individuals). Renal, cardiac, and splenic pathologies, Mycobacterium avium-intracellulare (MAI) infection, and cachexia were more common in blacks than in whites and/or Hispanic individuals, and cytomegalovirus and systemic lymphoma were more common in whites and Hispanic individuals than in blacks. Diseases associated with intravenous drug use were hepatitis C, cirrhosis, and tuberculosis; those with all sexual risk factors, cytomegalovirus infection, herpes simplex virus infection, and Pneumocystis carinii pneumonia; and those with homosexual risk, Kaposi sarcoma and MAI infection. The prevalence of many disease entities changed over time: compared with the other groups, group C had lower prevalences of many viral and fungal illnesses, MAI infection, systemic lymphoma, cachexia, and Kaposi sarcoma and higher prevalences of hepatitis, cirrhosis, arteriosclerosis, staphylococcal and streptococcal infections, and traumatic lesions. When the data were adjusted for changing demographic and risk composition, the only significant changes in disease frequency for period C were decreased prevalences of PCP and Kaposi sarcoma and increased prevalences of cirrhosis and arteriosclerosis. Conclusions Significant gender- and ethnicity-related differences in age of death occurred in this HIV-infected population, and these differences were not explained by the frequencies of diseases. The lower prevalences of PCP and Kaposi sarcoma in group C are likely a reflection of the impact of potent therapies on causes of mortality. The higher prevalences of cirrhosis and arteriosclerosis suggest that entities not targeted by antiretroviral reconstitution of immunity will play an increasingly important role in HIV-related mortality in the future.

Multiple reflective channels in the spleen: a sonographic sign of portal hypertension.

We consistently observed small "reflective channels" (RCs) in the splenic parenchyma in patients with portal hypertension (PHT). The purpose of this study was to investigate the frequency of this sign in PHT and in splenic disorders unrelated to PHT compared to normal controls. The significance of this sign in the diagnosis of PHT and in differentiating PHT splenomegalies from others was also assessed. A total of 337 patients underwent sonographic examination of the spleen: 147 normal, 75 non-PHT splenic pathologies, and 115 with PHT. The RCs were scored from grade 0 to 3 by counting the number in an area of 12 mm2 in the splenic parenchyma. Of 222 normal and non-PHT spleens, 174 (78%) showed grade 0, 44 (20%) grade 1, four grade 2 (1%), and none showed grade 3 RCs. Of 115 PHT cases, 17 showed grade 0, 25 grade 1, 44 grade 2, and 29 showed grade 3 RCs. The sensitivity of this sign was 0.85 with a specificity of 0.77 and an accuracy of 0.80 in detecting PHT (p < 0.001). The interobserver and intraobserver variation for grading was insignificant (p > 0.1). The RCs could be explained by periarterial fibrosis and dilatation of venous sinuses with increased collagen in their walls, which is known to occur in PHT. The vascular nature on ultrasound (US) was confirmed by the presence of flow on color Doppler. This sign is readily differentiated from the calcifications of tuberculosis, histoplasmosis, sickle cell infarcts, and phleboliths; it serves as a useful aid in diagnosing and differentiating PHT splenomegaly from non-PHT splenomegaly.