Management of Massive Splenomegaly

57-year-old man presented with a 3-month history of fatigue, fever and increasing abdominal pain.He had completed treatment for follicular lymphoma and JAK2 positive myeloproliferative disorder 2 months previously. This case demonstrates therapeutic and diagnostic rationale for open splenectomy in, to our knowledge, one of the largest recorded spleens

Report on four cases of the rarest benign splenic tumor - myoid angioendothelioma, with literature review

Introduction. Myoid angioendothelioma of the spleen is an extremely rare form of a benign splenic tumor. There is no characteristic symptomatology for this disease. Case outline. We present four patients operated on for myoid angioendothelioma of the spleen. Three patients were without problems while one had nonspecific problems. Two patients underwent laparoscopic surgery and two underwent open splenectomy. In all patients, the definitive diagnosis was confirmed by histopathological examination. Discussion. By reviewing the aforementioned medical databases of published papers in English, we found a total of eight cases of myoid angioendothelioma of the spleen. In addition to the mentioned number, we have added our series of cases. Conclusion. Twenty-one years after the discovery of myoid angioendothelioma of the spleen, the small number of cases presented in the literature is still a limiting factor in making conclusions and in learning lessons about this disease

Pathogenic potential of Parabacteroides distasonis revealed in a splenic abscess case: a truth unfolded

Splenic abscess is a rare entity, however if unrecognised or left untreated, it is invariably fatal. We herein report a case of splenic abscess in a 40-year-old man presenting with fever, left-sided abdominal pain, altered sensorium and vomiting. On clinical examination, hepatosplenomegaly was noted and the ultrasound of the abdomen showed multiple hypoechoic regions in the upper pole of spleen, and the diagnosis of splenic abscess was made. The patient received antimicrobial therapy and underwent an open splenectomy with full recovery. Pus aspirated from the splenic abscess grew an unusual organism named Parabacteroides distasonis. In the literature, there are only a few recorded cases of P. distasonis causing splenic abscess. Through this case report, we would like to emphasise the pathogenic role of P. distasonis in causing clinical disease, as this organism is typically known to constitute a part of the normal flora.

Splenectomy in Jamaican children with sickle cell disease: Outcome of selective blood transfusion

We reviewed the post-operative morbidity and mortality of open splenectomy undertaken in conjunction with selective blood transfusion in Jamaican children with sickle cell disease. Data were collected on 150 splenectomies performed between November 1994 and October 2017. Selective blood transfusion involved raising haemoglobin levels to approximately 100 g/L in patients with admission haemoglobin ≥10 g/L below steady state. There was no mortality. Mean post-operative stay was 3.2 days with a median of three days. Total morbidity was 19/150 cases (12.7%), with acute chest syndrome accounting for 11/19 (57.9%). Among the non-transfused, acute chest syndrome occurred in 10/117 cases (8.5%), while among transfused, acute chest syndrome occurred in 1/33 cases (2.9%). We recommend this selective blood transfusion protocol for patients with sickle cell disease to surgeons who undertake splenectomies in settings where blood bank reserves are perennially low.