Splenectomy

Question 1

Indications

Answer 1

Trauma: 1/4 are iatrogenic

Spontaneous rupture: EBV

Hypersplenism: hereditary spherocytosis or elliptocytosis etc

Malignancy: lymphoma or leukaemia

Splenic cysts, hydatid cysts, splenic abscesses

Question 2

Management post-splenectomy

Answer 2

Vaccination - if elective, should be done 2 weeks prior to operation:

• Hib, meningitis A & C
• annual influenza vaccination
• pneumococcal vaccine every 5 years

Antibiotic prophylaxis
- penicillin V: continued for at least 2 years and at least until the patient is 16 years of age (but most use throughout life)

Question 3

Post-splenectomy Complications

Answer 3

• Haemorrhage (may be early and either from short gastrics or splenic hilar vessels
• Pancreatic fistula (from iatrogenic damage to pancreatic tail)
• Thrombocytosis: prophylactic aspirin
• Encapsulated bacteria infection/ sepsis e.g. Strep. pneumoniae,
  Haemophilus influenzae and Neisseria meningitidis

Question 4

Post-splenectomy Changes

Answer 4

Platelets will rise first (therefore in ITP should be given after splenic artery clamped)

Blood film will change over following weeks, Howell-Jolly bodies will appear

Other blood film changes include target cells and Pappenheimer bodies