Partial splenectomy for a 3-year-old child with sickle cell disease, hb-c with a crisis.

Explanation:

The spleen is the largest reticuloendothelial organ of mesodermal origin. The splenomegaly defines the spleens' weight more than 500 mg and/or 15 cm or more in length, palpable below the left costal margin. The blood supply originates from the splenic and short gastric artery. Spleen is positioned by splenocolic, gastrosplenic, phrenosplenic and splenorenal ligaments. The spleen consists of red and white pulp. The functions of the spleen are filtration, host defence, storage and cytopoiesis.

Partial splenectomy is indicated in children (risk of splenectomy sepsis), lipid storage disorders (Gaucher’s disease), repeated transfusions or anaemic crisis and blunt and/or penetrating splenic injuries. Partial splenectomy is as well indicated in children with congenital hemolytic anaemia, congenital erythrocyte membrane disorder or enzyme disorder, pyruvate kinase deficiency, congenital non-spherocytotic hemolytic anaemia of unknown aetiology, congenital hemoglobinopathy (HgbSC disease, HgbSS disease, HgbCC disease or combined HgbS-β-thalassemia). Following partial splenectomy, the splenic phagocytic function is partially preserved.

The aim is to remove enough of spleen tissue to have a good hematologic effect.  

In the case of open splenectomies, the position of the patient is supine with the midline incision performed. In the case of elective splenectomies, the left subcostal incision is performed.

After the left subcostal incision, the spleen is partially devascularized to maintain the flow from gastric arteries. Prior to splenic transection, the devascularized tissue is compressed to auto transfuse the remaining blood back into the patient.

The bleeding from the cut surface of the spleen is controlled by cauterization, argon coagulation and application of hemostatic agents.

In the case of laparoscopic splenectomy, the position is supine or low lithotomy with the placement of 5- 6 trocars. In case of right lateral decubitus, there are 3-4 trocars. Thus, the excised spleen is then placed in a nylon sac and extracted with a blunt instrument to avoid spillage.

There are certain changes in blood after splenectomy such as the appearance of Howell-Jolly bodies and siderocytes, leukocytosis and increased platelet counts.

The incidence of post splenectomy infection is lowered due to the pneumococcal vaccine.  

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