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Introduction: Total splenectomy in sickle cell disease is related to a high risk of fulminant sepsis and increased incidence of other events, which have not been reported in patients with partial splenectomy. In this study we examined the patients with sickle cell disease and partial splenectomy and compared the clinical and laboratory results with non-splenectomised patients. Materials and methods: We studied 54 patients with sickle cell disease who underwent partial splenectomy in childhood from 1986 until 2011 at the Institute of Hematology and Immunology. They were compared with 54 non-splenectomised patients selected by random sampling with similar characteristics. Results: Partial splenectomy was performed at a mean age of 4.1 years, with a higher frequency in homozygous haemoglobin S (70.4%), and the most common cause was recurrent splenic sequestration crisis. The most common postoperative complications were fever of unknown origin (14.8%) and acute chest syndrome (11.1%). After splenectomy there was a significant increase in leukocytes, neutrophils, and platelets, the latter two parameters remained significantly elevated when compared with non-splenectomised patients. There was no difference in the incidence of clinical events, except hepatic sequestration, which was more common in splenectomised patients. Conclusion: Partial splenectomy was a safe procedure in patients with sickle cell disease. There were no differences in the clinical picture in children splenectomised and non-splenectomised except the greater frequency of hepatic sequestration crisis in the first group. Resumen: Introducción: La esplenectomía total en la drepanocitosis se relaciona con riesgo de infecciones sobreagudas y con aumento de la incidencia de otros eventos, lo que no se ha comunicado en pacientes con esplenectomía parcial. En este estudio se caracterizó a los pacientes con drepanocitosis y esplenectomía parcial, y se comparó el comportamiento clínico y de laboratorio con los pacientes no esplenectomizados. Materials y métodos: Se estudió a 54 pacientes con drepanocitosis sometidos a esplenectomía parcial durante la edad pediátrica, desde 1986 hasta el año 2011, en el Instituto de Hematología e Inmunología. Se compararon con 54 pacientes no esplenectomizados seleccionados por muestreo aleatorio con características similares. Resultados: La esplenectomía parcial se realizó a una edad media de 4,1 años, con una frecuencia mayor en la anaemia drepanocítica (70,4%) y su causa más común fue la crisis de secuestro esplénico recurrente. Las complicaciones posoperatorias más frecuentes fueron: fiebre de origen desconocido (14,8%) y síndrome torácico agudo (11,1%). Después de la esplenectomía, aumentaron significativamente los leucocitos, neutrófilos y plaquetas; estos 2 últimos parámetros se mantuvieron elevados de manera significativa cuando se compararon con los pacientes no esplenectomizados. No hubo diferencias en la incidencia de los eventos clínicos, excepto el secuestro hepático, que fue más frecuente en los esplenectomizados. Conclusión: La esplenectomía parcial constituyó un proceder seguro en los pacientes con drepanocitosis. No hubo diferencias en el cuadro clínico entre los niños esplenectomizados y los no esplenectomizados, salvo la mayor frecuencia de crisis de secuestro hepático en los primeros.

Highlights • First published case of subtotal splenectomy preserving the inferior splenic pole without the maintenance of the splenic vascular pedicle. • A very large spleen Hodgkin’s disease was successfully treated using a partial splenectomy. • A successful surgical treatment on a Hodgkin’s lymphoma refractory to chemo and radiotherapy. • The patient is still alive after more than 11 years from the subtotal splenectomy. • Subtotal splenectomy is efficacious to preserve the splenic functions and to prevent adverse effects of a large spleen on the treatment of Hodgkin’s lymphoma. • Subtotal splenectomy is sufficient to reduce the inconvenience of a huge spleen on patient symptoms and disorders of the hematological and immunological system., Introduction Splenectomy is helpful in the management of selected patients with Hodgkin’s lymphoma (HL), but in some cases this procedure is accompanied by a greater morbidity and mortality mainly due to sepsis. This is the first published case of subtotal splenectomy preserving the inferior splenic pole without the maintenance of the splenic vascular pedicle. Presentation of case A 53-year-old man with HL refractory to chemo and radiotherapy associated to a very large spleen was successfully treated with subtotal splenectomy, preserving the inferior splenic pole supplied only by the left gastroepiploic and inferior splenic pole vessels. After an eleven year uneventful postoperative follow-up, the dimensions and function of the spleen are still preserved, and the disease is under control with chemo- and radiotherapy. Conclusion Subtotal splenectomy is efficacious to preserve the splenic functions and to prevent adverse effects of a large spleen on the treatment of Hodgkin’s lymphoma confined to superior pole and producing significant abdominal symptoms and hematological effects.

Background Splenic involvement secondary to blunt abdominal trauma is often treated by performing a splenectomy. The severity of the post-splenectomy syndrome is currently well known (blood loss, sepsis), so there is an increasing tendency to preserve the spleen. The case is presented of splenic preservation after blunt abdominal trauma with hilum involvement, emphasising the role of Floseal® as a haemostatic agent, as well as the use of resorbable meshes to preserve the spleen. Clinical case A 22-year-old woman presenting with a grade IV splenic lesion secondary to a blunt abdominal trauma after a traffic accident. Partial splenic resection was performed and bleeding was controlled with Floseal® and use of a reinforcing polyglycolic acid mesh. No postoperative complications occurred, being discharged on day 5. The long-term follow-up has been uneventful. Conclusion The use of haemostatic agents such as thrombin and the gelatine gel (FloSeal®) and the use of polyglycolic acid meshes enable spleen-preserving surgery, making it a feasible and reproducible procedure and an alternative to classical splenectomy.

Os reticulócitos são células eritróides que exibem RNA residual e são liberados da medula óssea em resposta à hipoxia tecidual. Após sua liberação da medula óssea, ficam temporariamente seqüestrados no baço, onde adquirem forma de eritrócitos maturos. Além disso, o baço também é responsável pelo armazenamento do sangue e seus elementos. A esplenectomia é indicada para casos de torção ou ruptura esplênica, esplenomegalia sintomática e massas esplênicas. Este estudo tem como objetivo avaliar a resposta dos reticulócitos e do hematócrito em cães submetidos à remoção parcial do baço. Para isso, foram utilizados nove cães, sem raça definida, machos e fêmeas. As coletas foram feitas uma hora antes e 48, 96, 144 e 168 horas após o procedimento cirúrgico. Os resultados demonstraram que o hematócrito diminuiu significativamente após a esplenectomia parcial. O valor máximo de reticulócitos foi alcançado 96 horas após a cirurgia, a partir daí houve um declínio na quantidade de reticulócitos na corrente sangüínea, permanecendo, porém, em número superior à condição pré-esplenectomia parcial. The reticulocytes are erythroid cells that exhibit residual RNA, being released from bone marrow by erythropoietin stimulus in response to tissue hypoxia. After its release from bone marrow, they are temporarily sequestred in the spleen, where they acquire form of mature erythrocytes. Besides, the spleen is also responsible for storage of the blood and their elements. The splenectomy is indicated in cases of splenic torsion or rupture, symptomatic splenomegaly, and splenic masses. This study aimed to evaluate the response of reticulocytes and of hematocrit in dogs submitted to partial splenectomy. Nine mongrel males and female dogs were used. The samples were obtained one hour before the surgery and 48, 96, 144 and 168 hours after this procedure. The findings demonstrated that the hematocrit decreases significantly after the partial splenectomy. Highest values reticulocytes were reached 96 h after the surgery, followed by a decline in number, nevertheless, the counting was higher than moments before of the partial splenectomy.

PURPOSE: Over the past 21 years, we have performed more than 200 subtotal splenectomies, in which the upper splenic pole vascularized only by the gastrosplenic pole vascularized only by the gastrosplenic vessels is preserved, to treat different pathologic conditions. A meticulous follow-up of the postoperative results of this procedure is of fundamental importance. METHODS: All patients undergoing subtotal splenectomy were invited to be reviewed. A total of 86 patients who had undergone surgery 1 to 20 years ago were gathered; the surgical procedure was performed for one of the following conditions: portal hypertension due to schistosomiasis (n = 43), trauma (n = 31), Gaucher's disease (n = 4), myeloid hepatosplenomegaly due to myelofibrosis (n = 3), splenomegalic retarded growth and sexual development (n = 2), severe pain due to splenic ischemia (n = 2) and pancreatic cystadenoma (n = 1). Patients underwent a hematologic exam, an immunologic assessment, abdominal ultrasonography, computed tomography, scintigraphy and endoscopy. RESULTS: Increased white blood cell count and platelets were the only hematological abnormalities. No immunologic deficit was found. Esophageal varices were still present in patients who underwent surgery because of portal hyperension although without rebleeding. The ultrasound, tomography and scintigraphy exams confirmed the presence of functional splenic remnants without significant size alteration. CONCLUSIONS: Subtotal splenectomy seems to be a safe procedure that can be useful in treating conditions involving the spleen. The functions of the splenic remnants are preserved during long periods of time. OBJETIVO: Durante 21 anos, realizamos mais de 200 esplenectomias subtotais para tratar diferentes condições patológicas. É fundamental conhecer os resultados pós-operatórios desse procedimento. MÉTODO: Todos os pacientes submetidos a esplenectomia subtotal foram convidados para serem submetidos a revisão. Pudemos reunir 86 pacientes operados em um período de um a vinte anos por hipertensão porta esquistossomática com sangramento prévio pelas varizes (n = 43), trauma (n = 31), doença de Gaucher (n = 4), hepatoesplenomegalia mielóide devido a mielofibrose (n = 3), retardo de desenvolvimento somático e sexual esplenomegálico (n = 2), dor intensa por isquemia esplênica (n = 2) e cistoadenoma corpocaudal pancreático (n = 1). Os pacientes foram submetidos a exame hematológico, avaliação imunológica, ultra-som, tomografia computadorizada, cintilografia e endoscopia digestiva alta. RESULTADOS: Aumento do número de leucócitos e plaquetas foram a única alteração hematológica encontrada. Não foram constatados distúrbios imunológicos. Varizes esofágicas ainda estavam presentes em pacientes operados de hipertensão porta, porém sem ressangramento. O ultra-som, a tomografia computadorizada e a cintilografia confirmaram a presença do remanescente esplênico funcionante, sem mudanças em seu tamanho. CONCLUSÃO: A esplenectomia subtotal parece ser um procedimento seguro e pode seu útil para tratar condições nas quais o baço estiver envolvido.

ResumenAntecedentesLa afectación esplénica secundaria a un traumatismo abdominal cerrado es frecuentemente tratada mediante esplenectomía. Ante la gravedad de las consecuencias del síndrome postesplenectomía (pérdidas hemáticas, sepsis, etc.) cada vez se tiende más a la preservación del órgano afectado. Presentamos un caso clínico de preservación de bazo tras traumatismo abdominal cerrado con implicación hiliar de dicho órgano, en el que se recurre al papel esencial del Floseal® como agente hemostático.Caso clínicoMujer de 22 años que presenta traumatismo abdominal cerrado tras accidente de tráfico, con diagnóstico de lesión esplénica del polo inferior con compromiso hiliar que implica la vascularización de dicha región. Se procede a la intervención quirúrgica urgente con preservación esplénica mediante esplenectomía parcial y control del sangrado con Floseal® y con el empleo de una malla de refuerzo de ácido poliglicólico. La evolución postoperatoria es satisfactoria y sale del hospital al 5.o día sin incidencias.ConclusiónEl empleo de agentes hemostáticos como el gel de gelatina y trombina (Floseal®) y el uso de mallas envolventes de ácido poliglicólico posibilitan la cirugía de preservación esplénica tras un traumatismo abdominal, representando una alternativa segura y factible a la esplenectomía completa clásica, con el beneficio de la conservación del órgano y de sus funciones.AbstractBackgroundSplenic involvement secondary to blunt abdominal trauma is often treated by performing a splenectomy. The severity of the post-splenectomy syndrome is currently well known (blood loss, sepsis), so there is an increasing tendency to preserve the spleen. The case is presented of splenic preservation after blunt abdominal trauma with hilum involvement, emphasising the role of Floseal® as a haemostatic agent, as well as the use of resorbable meshes to preserve the spleen.Clinical caseA 22-year-old woman presenting with a grade IV splenic lesion secondary to a blunt abdominal trauma after a traffic accident. Partial splenic resection was performed and bleeding was controlled with Floseal® and use of a reinforcing polyglycolic acid mesh. No postoperative complications occurred, being discharged on day 5. The long-term follow-up has been uneventful.ConclusionThe use of haemostatic agents such as thrombin and the gelatine gel (FloSeal®) and the use of polyglycolic acid meshes enable spleen-preserving surgery, making it a feasible and reproducible procedure and an alternative to classical splenectomy.