Accessory splenectomy with gastroesophageal devascularization for recurrent hypersplenism and refractory bleeding varices in a patient with liver cirrhosis: report of a case.
We report a case of recurrent thrombocytopenia associated with symptomatic enlargement of an accessory spleen, 2 years after splenectomy, in a 36-year-old man with posthepatitic liver cirrhosis. The patient suffered three episodes of variceal bleeding, but the esophageal varices were not eradicated by two sessions of endoscopic injection sclerotherapy and endoscopic band ligation. Abdominal ultrasonography and computed tomography showed a giant accessory spleen (6 x 6 x 5 cm), gallbladder stones, and complete postsplenectomy splenomesoportal thrombosis. Subsequent 99mTc scintigraphy confirmed the presence of a functioning residual splenic nodule. Thus, we performed gastroesophageal devascularization (Hassab-Paquet procedure) with accessory splenectomy and cholecystectomy, after which the platelet count normalized and no further variceal bleeding occurred during 17 months of follow-up. To our knowledge, this is the first report in the English medical literature of accessory splenectomy for recurrent thrombocytopenia in a patient with liver cirrhosis.
Mishin
Igor
I
First Department of Surgery N.Anestiadi and Laboratory of Hepato-Pancreato-Biliary Surgery, Emergency Municipal Hospital, Medical University N.Testemitsanu, Kishinev, Moldova.
Ghidirim
Gheorghe
G
D000328:Adult; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis; D006801:Humans; D006971:Hypersplenism / Q000000981:diagnostic imaging* / Q000601:surgery*; D007813:Laparotomy / Q000379:methods; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis; D008297:Male; D011877:Radionuclide Imaging; D012008:Recurrence; D012086:Reoperation; D018570:Risk Assessment; D013154:Spleen / Q000002:abnormalities*; D013156:Splenectomy / Q000009:adverse effects* / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome