Complications of Splenectomy and Management.pptx

Complications of splenectomy

1. Complications of S plenectomy and Management.

2. Haemorrhage —mainly from short gastric vessels. Re-exploration and control of bleeding is needed or endoscopic clipping. Haematemesis due to mucosal congestion following ligation of short gastric vessels. Left sided pleural effusion and left basal atelectasis (left lower lobe atelectasis is the commonest complication) (30%). Minimized or avoided by incentive spirometry and chest physiotherapy. Left subphrenic abscess . Prompt diagnosis and Percutaneous drainage with catheter placement Haematologic changes: Rise in WBC and platelet count, rise in abnormal RBCs and RBC bodies.Postoperative thrombocytosis ( plt >1*10^6/ml) Prophylactic aspirin, Platelet apheresis or Anticoagulants

3. Infection — Post- splenectomy septicaemia , OPSI within 1st 2-3 years—most dangerous. Due to lose of splenic macrophages, lose of reticuloendothelial screening function. This system is particularly suited to the removal of encapsulated bacteria, whose polysaccharide coating is a natural defense against opsonization . Infections with protozoa that invade the red blood cell occur more frequently in splenectomized individuals than in normal hosts. In the absence of the spleen, elimination of these pathogens from the bloodstream falls solely to the liver, a process that has been demonstrated to be less effective. Managed by antibiotic prophylaxis, appropriate and timely immunization, education and prompt treatment of infection .

4. Gastric fistulas (may result from damage to the greater curvature of the stomach during ligation of the short gastric vessels). Damage to the tail of the pancreas may result in pancreatitis, a localised abscess or a pancreatic fistula. Conservative or surgical repair Left sided colonic injury . Gastric Dilatation the laxity of supporting ligaments makes the stomach more prone to rotation and consequently leading to volvulus. Splenectomy for massive splenomegaly requires division of gastric ligaments and the residual dead space provide room for gastric rotation. Portal vein thrombosis can occur. DVT as a late sequel after splenectomy is often dangerous. Risk is 4 times more than in non- splenectomised people and so also pulmonary embolism. It is better to put them on long-term small dose of aspirin to reduce the incidence of thromboembolism.

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