The major longterm complication of splenectomy is opsi, also known as post splenectomy sepsis syndrome, which is defined as a generalized nonspecific flulike prodrome followed by rapid deterioration to fullblown fulminant septic shock within 2448 hours of the onset. Opsi is a rapidly progressive fulminant infection linked to spontaneous. Postsplenectomy and hyposplenic states antonio di sabatino, rita carsetti, gino roberto corazza the spleen is crucial in regulating immune homoeostasis through its ability to link innate and adaptive. In individuals with neutropenia and felty syndrome who have recurrent lifethreatening bacterial infections, splenectomy is the treatment of choice, though the response is often short lived. The clinical course of feltys syndrome compared to matched controls. Your spleen is a beanshaped organ found under your ribs on the left upper side of your abdomen stomach. Background open splenectomy is performed in two major clinical scenarios. Overwhelming postsplenectomy infection opsi is a serious fulminant process that carries a high mortality rate24. Partial splenectomy leaves behind role of splenectomy for. Prolonged survival after splenectomy in wiskottaldrich. Our case confirms that prolonged survival can be achieved postsplenectomy in patients with was, given that there is a systematic approach in their postsplenectomy medical care. Coincidental splenectomy in chronic fatigue syndrome. Evidencebased information on post splenectomy prophylaxis from hundreds of trustworthy sources for health and social care.
The patient had a twoyear history of cfs prior to her involvement in a road crash. Increased risk for severe infections from bacteria such as streptococcus pneumoniae and neisseria meningitidis. Late septic complications in adults following splenectomy for trauma. What are other complications related to splenectomy. The spleen is in the uppermost area of the left side of the abdomen, just under the.
Opsi is a syndrome of fulminant sepsis occurring in splenectomized asplenic or hyposplenic individuals that is associated with high mortality and morbidity. To assess the frequency of splenic vein thrombosis svt after splenectomy and its consequences on patient treatment. Management of postoperative complications following. It consists of a group of symptoms and signs such as. Risk of infection and death among postsplenectomy patients. Prevention and management of overwhelming postsplenectomy. Splenectomy may be followed by severe systemic infection because such surgery removes the splenic macrophages that filter and phagocytose bacteria and other bloodborne. Overwhelming postsplenectomy infection syndrome in adults a. The spleen is one of the most frequently injured intraperitoneal organs, and. The risk of overwhelming infection postsplenectomy remains lifelong and is highest in immunocompromised patients. Opsi is a syndrome of fulminant sepsis occurring in splenectomized asplenic. Overwhelming postsplenectomy infection opsi is the most formidable infectious complication in the splenectomized patient. Pdf successful treatment of evans syndrome post liver. It is now widely accepted that the splenectomized individual is at increased risk for infection, in particular, overwhelming postsplenectomy infection opsi.
However, recognition and clinical management of opsi is not well established. Laparoscopic splenectomy is surgery to take out all or a part of your spleen. Asplenia is a form of immunodeficiency, increasing the risk of sepsis from polysaccharide encapsulated bacteria, and can result in overwhelming post splenectomy infection opsi, often fatal within a few. This is the first case ever of neisseria cinerea bacteremia in a postsplenectomy patient and ninth case overall. The spleen is an important part of the bodys defense immune system. Splenectomy vaccination and antimicrobial prophylaxis. Overwhelming postsplenectomy infection opsi is a serious disease that. The spleen is a small, solid organ, located in the upper left side of the abdomen just under the rib cage. Postsplenectomy acute glomerulonephritis due to a chronic. Asplenia and splenic dysfunction are associated with an immunodeficiency that predisposes patients to a lifethreating sepsis syndrome called. Preventing severe infection after splenectomy the bmj.
The spleen has an abundance of lymphoid tissue, including splenic macrophages that attack encapsulated organisms. Splenectomized patients, in fact, have a significant higher infection risk, with an incidence of overwhelming postsplenectomy infection syndrome reported of 15 %, with a mortality rate of 3870. Patients who are asplenic or hyposplenic are at an increased risk for infection. Management of overwhelming postsplenectomy infection. Cureus neisseria cinerea in a postsplenectomy patient. It contains special white blood cells that destroy bacteria and help the body fight infections when you are sick. Overwhelming postsplenectomy infection opsi is a rare medical emergency, mainly caused by encapsulated bacteria, shortly progressing from a mild flulike syndrome to a fulminant, potentially. Overwhelming postsplenectomy infection syndrome in adults. Postsplenectomy syndrome can occur after surgery to remove the spleen. Treatment of postsplenectomy thrombotic complications. The major longterm complication of splenectomy is opsi, also known as postsplenectomy sepsis syndrome, which is defined as a.
It may develop immediately or as late as 65 years postsplenectomy 24. The spleen plays a role in immunity against bacterial infections. Due to decreased response to encapsulated bacteria, the principal bacteria involved in postsplenectomy sepsis are primarily streptococcus pneumoniae 50% to 70%, and neisseria meningitidis and. The postsplenectomy platelet count may rise to abnormally high levels thrombocytosis, leading to an increased risk of potentially fatal clot formation. A report also suggested that splenectomy could have triggered progression to aml in one case of mds, 11 and splenectomy could increase the risk of blastic transformation in agnogenic. Prior to that, treatment of hcvassociated thrombocytopenia was an important and unresolved problem9,10. Opsi is a syndrome of fulminant sepsis occurring in. Prompt management and aggressive treatment can alter the course of. Hematology a constellation of findings that follow splenectomy, which are most marked in the erythroid series, as the spleen is responsible for pitting and culling effete or. The spleen is an organ that sits under your rib cage on the upper left side of your abdomen. Opsi cases have been well documented, and more recently the. Medical complications following splenectomy emconsulte.
What is the role of splenectomy in the treatment of. Management of overwhelming postsplenectomy infection syndrome. Postsplenectomy syndrome information mount sinai new york. Role of splenectomy in the treatment of myelodysplastic. Medical complications following splenectomy sciencedirect. Overwhelming postsplenectomy infection opsi is a serious disease that can progress from a mild flulike illness to fulminant sepsis in a short time period. Reports of overwhelming postsplenectomy infection opsi began to. We describe seven cases of thrombosis of the portal and splenic vein after elective splenectomy. The full text of this article is available in pdf format. Mortality is significant and reported to be as high as 50% 4,5. Splenectomyinduced portal hypertension and pulmonary. 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 thirdgeneration cephalosporins for any post splenectomy fever.
The most critical action in the treatment of opsi is the immediate use of broad spectrum i. Learn about postsplenectomy syndrome, find a doctor, complications, outcomes, recovery and followup care for postsplenectomy syndrome. Splenectomy is a surgical procedure to remove your spleen. Riley, md, and jedda rupert, md, eglin air force base family medicine residency, eglin air force base, florida l eukocytosis, often defined as an ele.
Postsplenectomy infections are potentially severe with overwhelming post splenectomy infection opsi. Partial splenectomy is a form of splenic salvage and refers to the removal of a portion of the spleen based upon its segmental blood supply. According to the reasons for splenectomy, 14 patients with postsplenectomy hemorrhage were grouped into two groups. Pdf the spleen is an intraperitoneal organ that performs vital hematological and immunological functions. Successful treatment of evans syndrome post liver transplant with splenectomy and switch from tacrolimus to cyclosporine. Splenectomy lifelong precautions what is a splenectomy.
The utility of splenectomy as rescue treatment for severe acute antibody. Complications of splenectomy the american journal of medicine. The patient was successfully treated with intravenous ceftriaxone. The diagnosis was initially unrecognized in all patients and was confused with biliary. The duration of antimicrobial prophylaxis should be assessed foreach. The splenectomy can also be considered as a therapeutic option. We report a case of severe evans syndrome after a liver transplant. Postsplenectomy syndrome definition of postsplenectomy. A splenectomy is an operation to remove the spleen.
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