Laparoscopic splenectomy: how minimal can we make it?

Aims Laparoscopic splenectomy (LS) is routinely performed in children, however, a large spleen in a small child can pose significant operative challenges. We instigated a highly standardised surgical and anaesthetic approach to LS to minimise surgical trauma and enhance recovery. The aim of this study was to assess the outcomes of this programme. Methods Prospective study of all LS’s performed 2018–2021. Surgical approach was via one 10 mm and three 5 mm ports. Early hilar control was accomplished with Hem-o-loks. Splenic retrieval via the 10 mm incision used finger morcellation within an Espiner EcoSac. Anaesthesia utilised a standardised regime of agents and bupivacaine was infiltrated to the splenic bed and wound sites. Post-operative opiates were minimised. Data are presented as median [IQR]. Results Twenty consecutive children were included. Indications for LS were hereditary spherocytosis (n = 12), sickle cell disease (n = 6), beta-thalassaemia (n = 1) and splenic haemangiomatosis (n = 1). Age at surgery was 101 months [75–117] and weight 30 kg [21–37]. Splenic size was 13.4 cm [12–14.4]. Operative time was 178 min [156–185]. There were no open conversions and no significant intra or post-operative bleeding. One patient developed pancreatitis. Median post-operative pain score was 1 [1–3]. Median length of stay was 2 days [2–3]. Conclusion LS is feasible, safe and efficient in smaller children with large spleens. This standardised programme of anaesthesia and surgery based around a core team reliably results in few complications, good analgesia and short length of stay.

Isolated splenic vein thrombosis as a complication of abdominal trauma in a 3-month-old girl

Falls from heights and traffic accidents are the most common causes of splenic damage. Abdominal trauma can cause splenic rupture or splenic vein thrombosis. About 11–55% of children with splenic vein thrombosis develop collateral circulation, leading to gastric and/or oesophageal varicose veins. Venous thrombosis in children can be also caused by congenital factors associated with coagulation disorders. The paper describes a case of a 3-month-old girl who developed isolated splenic vein thrombosis after a fall from height. Laboratory and genetic findings excluded thrombophilia. A 3-month anticoagulant treatment was administered. Gradual reduction in splenic size and the development of collateral circulation were observed in subsequent ultrasound scans. The girl remains under the care of a surgical clinic. The presented case of an infant with splenic vein thrombosis draws attention to possible complications of abdominal trauma after a fall from height.

Effects of Butorphanol With Alfaxalone or Dexmedetomidine on Feline Splenic Size and Appearance on Ultrasound and Computed Tomography

The purpose of the study was to determine the effects of intramuscular butorphanol with dexmedetomidine or alfaxalone on feline splenic size, echogenicity, and attenuation using ultrasound and computed tomography (CT). Ten healthy research cats underwent ultrasound and CT without sedation (controls), 15 min after protocol AB (alfaxalone 2 mg/kg and butorphanol 0.2 mg/kg) and 10 min after protocol DB (dexmedetomidine 7 μg/kg and butorphanol 0.2 mg/kg), with a one-week wash-out period between each sedation, using a cross-over study design. Images were randomized and anonymized for evaluation by a board-certified radiologist. On ultrasound, the sedative protocols affected splenic thickness, at the body and the tail (p = 0.002 and 0.0003, respectively). Post-hoc tests revealed that mean ± SEM thickness was greater after AB (body: 10.24 ± 0.30 mm; tail: 7.96 ± 0.33 mm) than for the control group (body: 8.71 ± 0.30 mm; tail: 6.78 ± 0.33 mm), while no significant difference was observed following DB. Splenic echogenicity was unchanged between treatments (p = 0.55). On CT, mean ± SEM splenic volume was increased after AB (37.82 ± 1.91 mL) compared to the control group (20.06 ± 1.91 mL) (p < 0.0001), but not after DB (24.04 ± 1.91 mL). Mean splenic attenuation increased after AB (p = 0.0009), but not DB. Protocol DB may be preferable for profound sedation in cats while avoiding changes in feline splenic imaging. When protocol AB is selected, splenomegaly should be expected, though mild on ultrasound. The increased splenic attenuation after AB is unlikely to be clinically relevant.

Role of Ultrasonography in Predicting Gastro-oesophageal Varices in Patients with Liver Cirrhosis

IntroductionUpper Gastrointestinal endoscopy is considered the best screening tool in detecting gastroesophagealvarices in patients with cirrhosis. Ultrasonography of the abdomen can be used forassessment of liver and portal system. This research was undertaken to demonstrate that theportal vein diameter and splenic size by ultrasonography can be used as a non-invasive predictorof gastro-esophageal varices. MethodsA cross-sectional hospital based study comprising of 290 consecutive patients with liver cirrhosiswere enrolled between November 2019 to November 2020. Clinical profile at admission andsonological splenic size and portal vein diameter were studied in all cirrhotic patients. Patientswere classified into 2 groups: one with presence of varices and second without varices. Data entrywas done in Statistical Packages for the Social Sciences version 20. ResultsThe mean age of subjects was 52±13.26 years with a range of 27 – 82 years of age (M:F=2:1). Thecommonest etiology of cirrhosis was chronic alcohol consumption. The prevalence of varices incirrhotics was 42.8%. Average portal vein diameter of patients without gastro-esophageal variceswas 11.12 ± 1.36 mm, while it was 12.81 ± 1.62 mm in patients with varices (p < 0.001). Averagespleen size in cirrhotics without varices was 12.44 ± 1.32 cm and with varices was 14.32 ± 2.42 cm.This difference was also statistically significant (p < 0.001). ConclusionsMeasurement of portal vein diameter and spleen size by ultrasonography can be recommendedas a non invasive predictor for gastro-oesophageal varices in patients with liver cirrhosis . Keywords: cirrhosis; portal vein diameter; spleen size; ultrasonography; gastro-oesophageal varices

Splenomegaly during oxaliplatin-based chemotherapy in colon cancer.

88 Background: Splenic enlargement has been reported in patients treated with oxaliplatin. However, the characteristics of oxaliplatin-induced splenomegaly were not well studied. Here we evaluated the change of splenic volume and its clinical significance in patients treated by oxaliplatin-based regimen. Methods: Patients with stage II-IV primary colon cancer treated with oxaliplatin and capecitabine in China National Cancer Center from January 2016 to December 2017 were screened for this retrospective study. Those with complete laboratory tests and computed tomographic data before, during and up to 1.5 years after the chemotherapy were selected. The splenic size was measured by AWVolumeshare5. Splenomegaly was defined as an over 30% increase of splenic size from baseline. Recovery of splenomegaly was defined as the splenic size fell back to a 0.9 to1.1-fold range of baseline. Results: Out of a total of 144 patients, 102 (70.8%) had over 30% increase, 72 (50.0%) had over 50% increase, and 22 (15.3%) had over 100% increase in splenic size after oxaliplatin-based regimen. Among the 102 splenomegaly patients, 5 (4.9%) develop splenomegaly within 3 chemotherapy cycles, 53 (53.0%) within 6 cycles, 73 (71.6%) within 9 cycles, and 102 (100.0%) within 3 months after the last administration of oxaliplatin. Compared to the group without splenomegaly, patients with splenomegaly received more cycles of oxaliplatin administrations (median 8 vs 6, p < 0.001) and greater dose intensity (total dose per square meter) (median 822.8mg/m2 vs 629.3mg/m2, p < 0.001). Patients with splenomegaly had higher incidence of thrombocytopenia (61.7% vs 38.1%, p = 0.009) and are more likely to undergo oxaliplatin dose reduction due to thrombocytopenia (21.6% vs 7.1%, p = 0.038). The recovery rates of splenic size within 0.5, 1 and 1.5 years after the end of oxaliplatin treatment were 23.2%, 50.6% and 74.3%, respectively. Conclusions: Splenomegaly are common in patients treated with oxaliplatin-based chemotherapy, and most would recover in 1.5 years after completion of therapy. Patients with splenomegaly are prone to experience thrombocytopenia and oxaliplatin dose reduction. Further studies are needed to reveal the mechanism how oxaliplatin induce splenomegaly.

Resveratrol Protects against Restraint Stress Effects on Stomach and Spleen in Adult Male Mice

The objectives were to investigate whether restraint stress (which is known as a mixture of psychologic and physical stress) exerts negative effects on the stomach and spleen, and whether the phenolic compound resveratrol (RES) exerts any protective roles. Fifty adult male mice were divided into five groups, with 10 mice per group as follows: control (C), restraint stress (RS), RS with vehicle (RS + V), RS with 2 mg/kg of resveratrol (RS + 2 mg RES), and RS with 20 mg/kg of resveratrol (RS + 20 mg RES). Mice were restrained in conical centrifuge tubes for 4 h daily to establish the RS model. RS + 2 mg RES, RS + 20 mg RES, and RS + V groups were given an oral dose of resveratrol or vehicle for 15 consecutive days, while the control group was not exposed to restraint stress. Herein, we showed that restraint stress decreased body weight and food and water consumption in stressed groups RS and RS + V compared to controls, while the groups treated with resveratrol showed improvements. Moreover, restraint stress caused acute damage to the morphology of gastric cells and reduced the quantitative distribution of parietal cells along with their decreased size and diameter, pointing to gastritis or ulcer. Furthermore, the antibody against the apoptosis-inducing factor (AIF) was highly attached in the RS groups. Splenic size, weight, and length were also greatly augmented in the stressed groups compared to the controls, while these phenomena were not observed in the RS + 2 mg RES group. Our findings proved significant ameliorating effects of resveratrol against restraint stress in adult male mice.

Ultrasonographic honeycomb pattern of the spleen in cats: correlation with pathological diagnosis in 33 cases

Objectives The aim of this study was to evaluate the relationship between the ultrasonographic (US) diffuse honeycomb pattern (HCP) of the spleen and a pathological diagnosis in cats, and to assess the influence of transducer type on HCP visualisation. Methods Abdominal ultrasounds of cats with an HCP were reviewed and splenic size, shape, margination, other parenchymal alterations and splenic hilar lymphadenopathy were recorded. When applicable, images acquired with high-frequency linear and curvilinear transducers were compared to determine if an HCP was more frequently demonstrated on high-resolution images. A retrospective review of the corresponding splenic cytohistopathological samples was also performed. Results Thirty-three cats met the inclusion criteria. Five cases were diagnosed by histology and 28 by cytology, confirmed by PCR for antigen receptor rearrangements (PARR) in uncertain cases. There were 15 cases of lymphoid hyperplasia, eight cases of lymphoma (four B cell, three T cell and one large granular lymphocytes), six cats with splenitis, three with extramedullary haematopoiesis and one with histiocytic sarcoma. The prevalence of lymphoma in cats with an HCP of the spleen was 24%. Splenomegaly was the most frequent US feature associated with an HCP and was observed in all lymphoma cases. In the images obtained from both high-frequency linear and micro-convex transducers the visualisation of an HCP was enabled in all cases (24/24) and in 62.5% (15/24), respectively. Conclusions and relevance: Based on our findings, a US HCP of the spleen in cats can be associated with benign and malignant disorders and is infrequently associated with lymphoma in comparison with dogs. Cytological or histological examination, possibly supplemented by PARR, should always be performed for diagnostic support. Use of high-frequency linear transducers is recommended to properly recognise an HCP or subtle changes in splenic parenchyma.