Medical complications following splenectomy.
Splenectomy is attended by medical complications, principally infectious and thromboembolic; the frequency of complications varies with the conditions that led to splenectomy (hematologic splenectomy, trauma, presence of portal hypertension). Most infectious complications are caused by encapsulated bacteria (Meningococcus, Pneumococcus, Hemophilus). These occur mainly in children and somewhat less commonly in adults within the first two years following splenectomy. Post-splenectomy infections are potentially severe with overwhelming post-splenectomy infection (OPSI) and this justifies preventive measures (prophylactic antibiotics, appropriate immunizations, patient education) and demands prompt antibiotic management with third-generation cephalosporins for any post-splenectomy fever. Thromboembolic complications can involve both the caval system (deep-vein thrombophlebitis, pulmonary embolism) and the portal system. Portal vein thrombosis occurs more commonly in patients with myeloproliferative disease and cirrhosis. No thromboembolic prophylaxis is recommended apart from perioperative low molecular weight heparin. However, some authors choose to prescribe a short course of anti-platelet medication if the post-splenectomy patient develops significant thrombocytosis. Thrombosis of the portal or caval venous system requires prolonged warfarin anticoagulation for 3 to 6 months. Finally, some studies have suggested an increase in the long-term incidence of cancer in splenectomized patients.
Université Paris Diderot-Paris 7, Hôpital Beaujon, Service de Médecine Interne, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
R
R
Buzelé
Université Paris Diderot-Paris 7, Hôpital Beaujon, Service de Chirurgie Hépato-Bilio-Pancréatique, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
L
L
Barbier
Université Paris Diderot-Paris 7, Hôpital Beaujon, Service de Chirurgie Hépato-Bilio-Pancréatique, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
A
A
Sauvanet
Université Paris Diderot-Paris 7, Hôpital Beaujon, Service de Médecine Interne, 100, boulevard du Général-Leclerc, 92110 Clichy, France. Electronic address: bruno.fantin@aphp.fr.
B
B
Fantin
D006801:Humans; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D012307:Risk Factors; D013156:Splenectomy
Cancer risk; Infection; Septicemia; Splenectomy; Thromboembolic complications; Vaccination