Humans ; Spleen ; injuries ; physiology ; surgery ; Splenectomy

Abnormalities, Multiple ; surgery ; Adolescent ; Humans ; Male ; Spleen ; abnormalities ; Testis ; abnormalities

OBJECTIVE: To evaluate the clinical efficacy and adverse reactions of peginterferon-α2b for treatment of chronic myeloproliferative neoplasms (MPN). METHODS: We retrospectively analyzed the data of 107 patients with MPN, including 95 with essential thrombocythemia (ET) and 12 with polycythemia vera (PV), who all received peginterferon-α2b treatment for at least 12 months. The clnical and follow-up data of the patients were analyzed to evaluate the efficacy and adverse reactions of the treatment. RESULTS: After receiving peginterferon- α2b treatment, both ET and PV patients achieved high hematological remission rates, and the total remission rates did not differ significantly between the two groups (86% vs 78%, P>0.05). In the overall patients, the spleen index decreased by 13.5% (95%CI: 8.5%-18.5%) after the treatment. The patients with hematological remission showed a significantly greater reduction of the total symptom score than those without hematological remission (P < 0.01). The median percentage of JAK2V617F allele load of PV patients decreased from 67.23% (49.6%-84.86%) at baseline to 19.7% (0.57%-74.6%) after the treatment, and that of JAK2V617F-positive ET patients decreased from 48.97% (0.45%-74.24%) at baseline to 22.1% (0.33%-65.42%) after the treatment. Mild adverse reactions (grade 1-2) were observed in both ET and PV groups without significant differences between them. The overall incidence of thrombotic events during the treatment was 2.8% in these patients, and no serious adverse reactions were observed. CONCLUSION For patients with chronic myelodysplasia, peginterferon-α2b treatment can achieve a high peripheral blood cell remission rate and maintain a long-term stable state with good effect in relieving symptoms such as splenomegaly. Peginterferon- α2b treatment caused only mild adverse reactions, which can be tolerated by most of the patients.
Humans ; Retrospective Studies ; Neoplasms ; Alleles ; Plastic Surgery Procedures ; Spleen

Humans ; Spleen/surgery* ; Tomography, X-Ray Computed ; Disability Evaluation

Splenogonadal fusion is a rare developmental anomaly in which an abnormal connection between the splenic tissue and gonads or mesonephric derivatives is present. Less than 200 cases have been reported since it was first described in 1883. Preoperative misdiagnosis is common and may lead to unnecessary orchidectomy if testicular neoplasm is suspected. To avoid such outcomes, it is important to be aware of the features of splenogonadal fusion. We report the case of a five-month-old male infant with continuous-type, left-sided splenogonadal fusion, which was discovered during groin exploration for a scrotal mass. Although the lesion was first noted during an episode of nonspecific viral fever, such an association is uncommon. Preoperative ultrasonographic evaluation favoured a diagnosis of a large haemangioma. This is the first reported case of splenogonadal fusion from Sri Lanka.
Diagnosis, Differential ; Humans ; Infant ; Male ; Spleen ; abnormalities ; surgery ; Splenic Diseases ; diagnosis ; surgery ; Testicular Diseases ; diagnosis ; surgery ; Testis ; abnormalities ; surgery

Autoimmune thrombocytopenic purpura (AITP) is an autoimmune disorder that results from antiplatelet autoantibodies; these autoantibodies cause platelet destruction in the reticluoendothelial system. Oral corticosteroid therapy is the first line treatment. Splenectomy is the major treatment modality after the failure of more conservative medical therapy. Approximately 15% of the patients will relapse either soon after splenectomy or, as is less common, many years later. The presence of an accessory spleen should be sought. We experienced a patient with a known diagnosis of autoimmune thrombocytopenic purpura who had a worsening thrombocytopenia 11 years after splenectomy. This patient was diagnosed with an accessory spleen. Accessory splenectomy was performed with only a transient elevation of the platelets. We report here on this case with a review of the literature.
Adult ; Female ; Humans ; Purpura, Thrombocytopenic, Idiopathic/*surgery ; Recurrence ; Spleen/*abnormalities/radionuclide imaging/surgery ; *Splenectomy

BACKGROUNDSurgical treatment has become the standard treatment for nontraumatic diseases of the spleen. This meta-analysis compared the relative merits of laparoscopic splenectomy (LS) with open splenectomy (OS) for nontraumatic splenic diseases.

METHODSA literature search was performed to identify studies comparing perioperative outcomes in patients who underwent LS or OS for nontraumatic diseases. Pooled odds ratios (ORs) and weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated using a fixed- or random-effects model.

RESULTSThirty-five studies matched the selection criteria. Of the 7 269 patients included 3 981 underwent LS and 3 288 underwent OS for nontraumatic diseases. OS was associated with shorter operation time (WMD = 42.65, 95% CI: 25.58-59.73), whereas LS was associated with reduced operative blood loss (WMD = -133.95, 95% CI: -229.02 to -38.88), need for blood transfusion requirement (OR = 0.53, 95% CI: 0.39-0.72), overall postoperative morbidity rate (OR = 0.44, 95% CI: 0.38-0.51), postoperative mortality rate (OR = 0.38, 95% CI: 0.24-0.59), and length of hospital stay (WMD = -2.73, 95% CI: -3.34 to -2.12).

CONCLUSIONSLS is superior to OS for nontraumatic diseases, with reduced operative blood loss, need for blood transfusion, postoperative morbidity and mortality rates, and length of hospital stay, although OS is associated with reduced operation time. LS may be a good alternative to OS for patients with nontraumatic splenic diseases.

Humans ; Laparoscopy ; adverse effects ; methods ; Spleen ; surgery ; Splenectomy ; adverse effects ; methods ; Splenic Diseases ; surgery

Splenic hilar lymph node (LN) should be removed in a D2 lymph node dissection for the advanced proximal gastric cancer. After improving the surgical technology and renewing treatment concepts, spleen-preserving splenic hilar LN dissection has been accepted by more and more surgeons. Because the anatomy position of spleen is very deep, and the splenic vessel is various, laparoscopic spleen-preserving splenic hilar LN dissection may be more difficult. In order to do better in laparoscopic spleen-preserving splenic hilar LN dissection, surgeons should choose the suitable patients; take reasonable surgical approach and surgical steps. Moreover, knowing the anatomy variance well of splenic vessel is also very important too.
Humans ; Laparoscopy ; methods ; Lymph Node Excision ; methods ; Spleen ; surgery ; Stomach Neoplasms ; surgery

Objective: At present, surgeons do not know enough about the mesenteric morphology of the colonic splenic flexure, resulting in many problems in the complete mesenteric resection of cancer around the splenic flexure. In this study, the morphology of the mesentery during the mobilization of the colonic splenic flexure was continuously observed in vivo, and from the embryological point of view, the unique mesenteric morphology of the colonic splenic flexure was reconstructed in three dimensions to help surgeons further understand the mesangial structure of the region. Methods: A total of 9 patients with left colon cancer who underwent laparoscopic radical resection with splenic flexure mobilization by the same group of surgeons in Union Hospital of Fujian Medical University from January 2018 to June 2019 were enrolled. The splenic flexure was mobilized using a "three-way approach" strategy based on a middle-lateral approach. During the process of splenic flexure mobilization, the morphology of the transverse mesocolon and descending mesocolon were observed and reconstructed from the embryological point of view. The lower margin of the pancreas was set as the axis, and 4 pictures for each patient (section 1-section 4) were taken during middle-lateral mobilization. Results: The median operation time of the splenic flexure mobilization procedure was 31 (12-55) minutes, and the median bleeding volume was 5 (2-30) ml. One patient suffered from lower splenic vessel injury during the operation and the bleeding was stopped successfully after hemostasis with an ultrasound scalpel. The transverse mesocolon root was observed in all 9 (100%) patients, locating under pancreas, whose inner side was more obvious and tough, and the structure gradually disappeared in the tail of the pancreatic body, replaced by smooth inter-transitional mesocolon and dorsal lobes of the descending colon. The mesenteric morphology of the splenic flexure was reconstructed by intraoperative observation. The transverse mesocolon was continuous with a fan-shaped descending mesocolon. During the embryonic stage, the medial part (section 1-section 2) of the transverse mesocolon and the descending mesocolon were pulled and folded by the superior mesenteric artery (SMA). Then, the transverse mesocolon root was formed by compression of the pancreas on the folding area of the transverse mesocolon and the descending mesocolon. The lateral side of the transverse mesocolon root (section 3-section 4) was distant from the mechanical traction of the SMA, and the corresponding folding area was not compressed by the tail of the pancreas. The posterior mesangial lobe of the transverse mesocolon and the descending mesocolon were continuous with each other, forming a smooth lobe. This smooth lobe laid flat on the corresponding membrane bed composed of the tail of pancreas, Gerota's fascia and inferior pole of the spleen. Conclusions: From an embryological point of view, this study reconstructs the mesenteric morphology of the splenic flexure and proposes a transverse mesocolon root structure that can be observed consistently intraopertively. Cutting the transverse mesocolon root at the level of Gerota's fascia can ensure the complete resection of the mesentery of the transverse colon.
Colectomy/methods* ; Colon, Transverse/surgery* ; Colonic Neoplasms/surgery* ; Dissection ; Fascia/anatomy & histology* ; Humans ; Laparoscopy ; Mesentery/surgery* ; Mesocolon/surgery* ; Pancreas/surgery* ; Photography ; Spleen/surgery*

Sclerosing angiomatoid nodular transformation (SANT) of the spleen, a newly defined primary lesion of the spleen, is very rare. Immunohistochemistry is the only way to confirm the diagnosis of SANT. We present the clinical characteristics and postoperative outcomes of five SANT cases that underwent splenectomy from January 2007 to October 2010. Although SANT had specific imaging findings, differential diagnosis from other splenic tuomrs or malignant lesions preoperatively was difficult. The hand-assisted laparoscopic splenectomy was a useful and effective technique for the management and postoperative diagnosis of SANT. All SANT patients had good prognosis without recurrence after splenectomy.
Adult ; Angiomatosis ; diagnosis ; pathology ; surgery ; Female ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Spleen ; pathology ; surgery ; Splenic Neoplasms ; diagnosis ; pathology ; surgery