Laparoscopic accessory splenectomy for recurrent idiopathic thrombocytopenic purpura.
BACKGROUND
Splenectomy has 50% to 70% long-term efficacy for immune thrombocytopenic purpura (ITP). In some patients, relapse is due to the presence of residual accessory splenic tissue.


METHODS
A 44-year-old male had ITP since 1983 with splenectomy in 1985. He had a transient response, but then developed severe thrombocytopenia refractory to multiple modalities for 20 years. An accessory spleen was first visualized in 2000.


RESULTS
A laparoscopic accessory splenectomy was performed without difficulty. The patient had an initial response with a significant increase in platelet count. Although over time the thrombocytopenia recurred, there has been a long-term benefit in that the patient is on much lower doses of prednisone to maintain an adequate platelet count.


CONCLUSIONS
The finding of accessory splenic tissue after prior splenectomy may be an increasingly common problem in patients with recurrent ITP. Although reported response rates for resection of residual splenic tissue vary, the availability of a safe, less morbid, minimally invasive approach makes the decision to operate easier.
Choi
Yong U
YU
Michael E DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
Dominguez
Edward P
EP
Sherman
Vadim
V
Sweeney
John F
JF