Indications of splenectomy are all except: March 2008

Ans. C: Polycythemia Indications for splenectomy? Trauma - Commonest organ injured in blunt abdominal trauma - Associated with lower rib fractures - 25% injuries are iatrogenic - Delayed rupture of splenic haematoma Spontaneous rupture - Usually seen in those with massive splenomegaly (e.g. infectious mononucleosis) - Often precipitated by minor trauma Hypersplenism Hereditary spherocytosis or elliptocytosis - Idiopathic thrombocytopenic purpura Neoplasia - Lymphoma or leukaemic infiltration - Splenectomy not usually required for diagnosis - Only required if hypersplenism resistant to treatment With other viscera - Total gastrectomy - Distal pancreatectomy Other indications - Splenic Cysts - Hydatid Cysts Splenic abscesses Oppounist Post Splenectomy Infection (OPSI) Infection due to encapsulated bacteria 50% due to strep. Pneumoniae Other organisms include: - Haemophilus influenzae - Neisseria meningitidis Occurs post splenectomy in 4% patients without prophylaxis Moality of OPSI is approximately 50% Greatest risk in first 2 years post op