Splenectomy and influence of its histopathology in alteration of treatment paradigms.

Abstract :

Aims: To identify the histopathological outcomes of patients undergoing splenectomy for various diseases, analyze the benefit afforded to patients by splenectomy and to identify any unexpected histopathological outcomes, which alter the treatment paradigm.Methods: Patients with splenectomy from January-2015 to April-2018 were enrolled in the study, irrespective of indication. Patient were stratified into 5 groups (splenectomy for haematological diseases, as part of another procedure, blunt trauma abdomen, diagnostic splenectomy and splenic abscess) and assessed for alteration of treatment based on histopathology.Results: 179 patients underwent splenectomy. Haematological causes and blunt trauma were more common in patients less than 40 years whereas diagnostic splenectomy was more common above 40 years. Treatment was altered in 9.15% (15/164) patients with splenectomy for therapeutic indications, with established preoperative diagnosis, additional information gained revealed tuberculosis and myeloid metaplasia. Diagnostic splenectomy established a diagnosis 93.33% (14/15) patients. Conclusion: Splenectomy for any etiology may spring a histopathological surprise. In medically refractory Chronic ITP, splenectomy not only normalized platelet counts, but also helped to diagnose the underlying cause. Significant number of idiopathic splenomegaly harbor occult malignancies not amenable to diagnosis by lesser invasive means and merit a splenectomy. Splenectomy done with a therapeutic intent helps establish a diagnosis of co-existent pathology, which altered the treatment paradigm.

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