Postsplenectomy syndrome can occur after surgery to remove the spleen. The most critical action in the treatment of opsi is the immediate use of broad spectrum i. Postsplenectomy syndrome definition of postsplenectomy. However, most previous epidemiological information on the opsi syndrome is based. An overwhelming postsplenectomy infection opsi is a rare but rapidly fatal infection occurring in individuals following removal or permanent dysfunction of the spleen. The spleen is a small, solid organ, located in the upper left side of the abdomen just under the rib cage.
We describe seven cases of thrombosis of the portal and splenic vein after elective splenectomy. Overwhelming postsplenectomy infection opsi is the most formidable infectious complication in the splenectomized patient. Management of overwhelming postsplenectomy infection. It has many functions, one of which is to help fight certain types of bacterial infections. The risk of overwhelming infection postsplenectomy remains lifelong and is highest in immunocompromised patients. Prevention and management of overwhelming postsplenectomy. 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. In these patients, splenectomy had been performed for hematologic disorders n 12 or trauma n 1. It consists of a group of symptoms and signs such as. However, recognition and clinical management of opsi is not well.
Opsi is a rapidly progressive fulminant infection linked to spontaneous. Preventing severe infection after splenectomy the bmj. Waterhousefriderichsen syndrome, and death in a splenectomized patient free. Splenectomy may be followed by severe systemic infection because such surgery removes the splenic macrophages that filter and phagocytose bacteria and other bloodborne. To promote a fact sheet and patient advice card to help with care of patients pre and post. Overwhelming post splenectomy infection is usually caused by the encapsulated bacteria streptococcus. The diagnosis was initially unrecognized in all patients and was confused with biliary. Splenectomy is generally indicated in the patient with felty syndrome fs with nonhealing leg ulcers or with recurrent or severe infections eg, pneumonia or septicemia despite medical therapies. The combination of splenectomy and corticosteroids has been applied on an empirical basis for 20 years with reported. 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.
Background open splenectomy is performed in two major clinical scenarios. 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. Medical complications following splenectomy sciencedirect. The splenectomy can also be considered as a therapeutic option. Splenectomyinduced portal hypertension and pulmonary. The full text of this article is available in pdf format. Cureus neisseria cinerea in a postsplenectomy patient. Overwhelming postsplenectomy infection syndrome in adults a. Splenectomy vaccination and antimicrobial prophylaxis. Congenital asplenia can occur in isolation or may be associated with certain forms of congenital heart defects or heterotaxy syndromes. Empiric treatment for suspected overwhelming postsplenectomy infection advertisement.
An earlier series of reports mentioned liberal use of the splenectomy option based on the clinical findings alone. Overwhelming post splenectomy infection opsi, as this complication is called, is uncommon but has high mortality. Overwhelming postsplenectomy infection syndrome in adults. Laparoscopic splenectomy ls has become increasingly popular in recent years.
Overwhelming postsplenectomy infection opsi has a mortality rate of up to 50%. Postsplenectomy infections are potentially severe with overwhelming postsplenectomy infection opsi and this justifies preventive measures prophylactic antibiotics, appropriate immunizations, patient. The spleen has an abundance of lymphoid tissue, including splenic macrophages that attack encapsulated organisms. The spleen is one of the most frequently injured intraperitoneal organs, and. Medical complications following splenectomy emconsulte. Increased risk for severe infections from bacteria such as streptococcus pneumoniae and neisseria meningitidis. Treatment of postsplenectomy thrombotic complications has been. The most critical action in the treatment of opsi is the immediate use of broadspectrum i. Vascular complications after splenectomy for hematologic. Overwhelming postsplenectomy infection listed as opsi. Reports of overwhelming postsplenectomy infection opsi began to. What is the role of splenectomy in the treatment of. Post splenectomy syndrome can occur after surgery to remove the spleen.
Most children have mild disease with little interference with lifestyle. Overwhelming post splenectomy infection opsi is the most formidable infectious complication in the splenectomized patient. 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. The removal of the spleen as a treatment method was initiated from the. Overwhelming postsplenectomy infection with plesiomonas. Overwhelming postsplenectomy infection opsi is a serious disease that can progress from a mild flulike illness to fulminant sepsis in a short time period. Hypersplenism is not a disease itself, but is more of a. Thrombocytosis increased platelet count, which can cause blood. Postsplenectomy infection strategies for prevention in.
Overwhelming postsplenectomy infection opsi is a serious disease that. Overwhelming postsplenectomy infection how is overwhelming postsplenectomy infection abbreviated. The spleen, similar in structure to a large lymph node, acts as a blood filter. A splenectomy is recommended as a treatment for some conditions that cause hypersplenism and might be recommended as a treatment for others. Overwhelming postsplenectomy infection with plesiomonas shigelloides in a patient cured of hodgkins disease. The spleen is crucial in regulating immune homoeostasis through its ability to link innate and adaptive immunity and in protecting against infections. Overwhelming postsplenectomy infection opsi syndrome is a rare condition, but is associated with high mortality. Postsplenectomy infections are potentially severe with overwhelming post splenectomy infection opsi.
Opsi is a syndrome of fulminant sepsis occurring in splenectomized asplenic. The prevalence of splenectomy increased recently because it was a clinically effective treatment for hepatitis c virusassociated thrombocytopenia before. Splenectomy definition of splenectomy by medical dictionary. Because splenectomy may cause portal hypertension, which leads to intrapulmonary shunting, portal hypertension plays a role in the development of the hepatopulmonary syndrome in. A splenectomy is the surgical procedure that partially or completely removes the spleen. Splenectomy was first used for the treatment of ttp in 1927 baehr et al, 1936. Partial splenectomy is a form of splenic salvage and refers to the removal of a portion of the spleen based upon its segmental blood. Specific management required for postsplenectomy patients see below in.
The duration of antimicrobial prophylaxis should be assessed foreach. Postsplenectomy infection strategies for prevention in general practice pdf. Complications of laparoscopic splenectomy minimally. Splenosis is one type of ectopic splenic tissue the other being accessory spleen. The prevalence of splenectomy increased recently because it was a clinically effective treatment for hepatitis c virusassociated. Postsplenectomy infections are potentially severe with overwhelming postsplenectomy infection opsi.
Very rarely, the organism finds its way into the bloodstream causing severe bacteremia. Your spleen has been removed as part of your surgical procedure. With the advent of ct scan, selective management of splenic syndrome. It is an acquired condition and is defined as autoimplantation of one or more focal deposits of splenic tissue in various. The spleen is a darkpurple, beanshaped organ located in the upper left side.
We report a case of severe evans syndrome after a liver transplant. Splenectomy may be followed by severe systemic infection because such surgery removes the splenic macrophages that filter and phagocytose bacteria and other bloodborne pathogens. Predicting postconcussive syndrome following mild traumatic brain injury in. The presentation is nonspecific and there is often no obvious portal of infection. Neisseria cinerea is a commensal which usually resides in the human respiratory tract. Read article for free, from open access legal sources, via unpaywall. Splenectomy lifelong precautions what is a splenectomy. Prompt management and aggressive treatment can alter the course of disease. Splenectomy definition splenectomy is the surgical removal of the spleen, which is an organ that is part of the lymphatic system.
1238 1131 1156 1570 521 817 427 1541 553 574 22 823 11 2 527 1036 1354 286 588 874 1046 232 340 1304 423 112 553 1390 833 137 1197 940 551 880