Ischaemia and partial resection for control of splenic hyperfunction

Patients with blood dyscrasia are particularly susceptible to fulminant sepsis after splenectomy. We therefore examined the therapeutic response to partial splenic amputation in 2 patients and transcatheter splenic artery occlusion or embolization in 3 patients with splenic hyperfunction. Partial splenectomy relieved associated symptoms and corrected peripheral cytopenias while preserving a substantial splenic remnant on radionuclide scintiscan and preventing appearance of Howell–Jolly bodies in the peripheral blood. Gelatin sponge embolization promoted selective splenic infarction and also corrected peripheral cytopenias, thereby facilitating immunosuppression to prevent renal allograft rejection. Steel coil occlusion of the main splenic artery in a patient with hepatic cirrhosis, however, although initially reducing splenic inflow, ‘decompressing’ the mesenteric portal system and ameliorating pancytopenia ultimately proved of only temporary benefit, confirming the results of prior attempts to curtail splenic hyperfunction by interruption of the extrasplenic arterial supply alone. Partial splenic preservation or hyposplenism is preferable to total splenectomy but, depending on the mass of splenic tissue left behind and the nature of the stimulus for hypersplenism, a fine line may exist between haematological recurrence and increased risk of overwhelming sepsis.