title: Vanishing spleen after Nissen fundoplication: a case report.
abstract: Nissen fundoplication is a generally accepted treatment for severe gastro-oesophageal reflux after conservative management has failed. The surgical techniques and the complications that may develop following the operation have been well described. However, necrosis of the spleen is a rare complication. We report here a patient with Down syndrome with a vanishing spleen after a Nissen fundoplication, who died of overwhelming pneumococcal septic shock 7 months after the operation. Vascular anomaly in Down syndrome, inadvertent ligation of the splenic artery or volvulus of the spleen may have caused a compromised splenic arterial circulation.Conclusion Nissen fundoplication may be associated with vanishing spleen and, consequently, with devastating consequences.
authors.affiliation: Department of Paediatrics, Paediatric Intensive Care Unit, University Hospital Maastricht, Maastricht, The Netherlands. dijkman-maas@planet.nl
authors.forename: Koen P
authors.initials: KP
authors.lastname: Dijkman
authors.forename: L W Ernest
authors.initials: LW
authors.lastname: van Heurn
authors.forename: Piet L J M
authors.initials: PL
authors.lastname: Leroy
authors.forename: Gijs D
authors.initials: GD
authors.lastname: Vos
mesh_terms: D001344:Autopsy; D002675:Child, Preschool; D017809:Fatal Outcome; D005260:Female; D018662:Fundoplication / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications; D009336:Necrosis / Q000175:diagnosis / Q000209:etiology; D011183:Postoperative Complications; D012772:Shock, Septic / Q000175:diagnosis / Q000382:microbiology; D013154:Spleen / Q000098:blood supply / Q000473:pathology; D013157:Splenic Artery / Q000293:injuries; D013158:Splenic Diseases / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D013290:Streptococcal Infections / Q000175:diagnosis / Q000382:microbiology; D013296:Streptococcus pneumoniae / Q000302:isolation & purification