Overwhelming postsplenectomy infection opsi is a serious disease that. Splenectomized patients, in fact, have a significant higher infection risk, with an incidence of overwhelming postsplenectomy infection syndrome reported of 15 %, with a mortality rate of 3870. We describe seven cases of thrombosis of the portal and splenic vein after elective splenectomy. An overwhelming postsplenectomy infection opsi is a rare but rapidly fatal infection occurring in individuals following removal or permanent dysfunction of the spleen. Splenectomyinduced portal hypertension and pulmonary. A report also suggested that splenectomy could have triggered progression to aml in one case of mds, 11 and splenectomy could increase the risk of blastic transformation in agnogenic.
The clinical course of feltys syndrome compared to matched controls. The patient had a twoyear history of cfs prior to her involvement in a road crash. Overwhelming postsplenectomy infection syndrome in adults. The major longterm complication of splenectomy is opsi, also known as postsplenectomy sepsis syndrome, which is defined as a. A splenectomy is an operation to remove the spleen. It is now widely accepted that the splenectomized individual is at increased risk for infection, in particular, overwhelming postsplenectomy infection opsi.
Risk of infection and death among postsplenectomy patients. Opsi is a syndrome of fulminant sepsis occurring in splenectomized asplenic or hyposplenic individuals that is associated with high mortality and morbidity. Overwhelming postsplenectomy infection syndrome in adults a. The diagnosis was initially unrecognized in all patients and was confused with biliary.
The spleen is in the uppermost area of the left side of the abdomen, just under the. The spleen plays a role in immunity against bacterial infections. Overwhelming postsplenectomy infection opsi is a serious fulminant process that carries a high mortality rate24. Preventing severe infection after splenectomy the bmj. Opsi cases have been well documented, and more recently the. It contains special white blood cells that destroy bacteria and help the body fight infections when you are sick. Post splenectomy infections are potentially severe with overwhelming post splenectomy infection opsi and this justifies preventive measures prophylactic antibiotics, appropriate immunizations, patient education and demands prompt antibiotic management with thirdgeneration cephalosporins for any post splenectomy fever. Postsplenectomy syndrome can occur after surgery to remove the spleen. To assess the frequency of splenic vein thrombosis svt after splenectomy and its consequences on patient treatment. The patient was successfully treated with intravenous ceftriaxone. Postsplenectomy syndrome information mount sinai new york.
The spleen is an important part of the bodys defense immune system. Patients who are asplenic or hyposplenic are at an increased risk for infection. The spleen is a small, solid organ, located in the upper left side of the abdomen just under the rib cage. It helps fight infection and filters unneeded material, such as old or damaged blood cells, from your blood. Opsi is a syndrome of fulminant sepsis occurring in splenectomized asplenic. Medical complications following splenectomy sciencedirect.
Cureus neisseria cinerea in a postsplenectomy patient. However, recognition and clinical management of opsi is not well established. Coincidental splenectomy in chronic fatigue syndrome. Our case confirms that prolonged survival can be achieved postsplenectomy in patients with was, given that there is a systematic approach in their postsplenectomy medical care. Pdf the spleen is an intraperitoneal organ that performs vital hematological and immunological functions. Successful treatment of evans syndrome post liver transplant with splenectomy and switch from tacrolimus to cyclosporine. Splenectomy may be followed by severe systemic infection because such surgery removes the splenic macrophages that filter and phagocytose bacteria and other bloodborne. The postsplenectomy platelet count may rise to abnormally high levels thrombocytosis, leading to an increased risk of potentially fatal clot formation. The splenectomy can also be considered as a therapeutic option. Mortality is significant and reported to be as high as 50% 4,5. The risk of overwhelming infection postsplenectomy remains lifelong and is highest in immunocompromised patients.
Your spleen is a beanshaped organ found under your ribs on the left upper side of your abdomen stomach. Complications of splenectomy the american journal of medicine. Overwhelming postsplenectomy infection opsi is the most formidable infectious complication in the splenectomized patient. Laparoscopic splenectomy aftercare instructions what. A unique case of coincidental splenectomy for trauma during chronic fatigue syndrome cfs is presented. Overwhelming postsplenectomy infection opsi is a serious disease that can progress from a mild flulike illness to fulminant sepsis in a short time period. Background open splenectomy is performed in two major clinical scenarios. Management of overwhelming postsplenectomy infection. Late septic complications in adults following splenectomy for trauma. The spleen is one of the most frequently injured intraperitoneal organs, and. Partial splenectomy is a form of splenic salvage and refers to the removal of a portion of the spleen based upon its segmental blood supply. Learn about postsplenectomy syndrome, find a doctor, complications, outcomes, recovery and followup care for postsplenectomy syndrome. The full text of this article is available in pdf format.
Prevention and management of overwhelming postsplenectomy. The spleen has an abundance of lymphoid tissue, including splenic macrophages that attack encapsulated organisms. Prompt management and aggressive treatment can alter the course of. Because splenectomy may cause portal hypertension, which leads to intrapulmonary shunting, portal hypertension plays a role in the development of the hepatopulmonary syndrome in. Riley, md, and jedda rupert, md, eglin air force base family medicine residency, eglin air force base, florida l eukocytosis, often defined as an ele. Splenectomy lifelong precautions what is a splenectomy. Overwhelming postsplenectomy infection opsi is a rare medical emergency, mainly caused by encapsulated bacteria, shortly progressing from a mild flulike syndrome to a fulminant, potentially. Postsplenectomy infections are potentially severe with overwhelming post splenectomy infection opsi. Management of postoperative complications following. This is the first case ever of neisseria cinerea bacteremia in a postsplenectomy patient and ninth case overall. It may develop immediately or as late as 65 years postsplenectomy 24. What is the role of splenectomy in the treatment of.
Prolonged survival after splenectomy in wiskottaldrich. The duration of antimicrobial prophylaxis should be assessed foreach. We report a case of severe evans syndrome after a liver transplant. Asplenia is a form of immunodeficiency, increasing the risk of sepsis from polysaccharide encapsulated bacteria, and can result in overwhelming post splenectomy infection opsi, often fatal within a few. Prior to that, treatment of hcvassociated thrombocytopenia was an important and unresolved problem9,10. Opsi is a rapidly progressive fulminant infection linked to spontaneous. The major longterm complication of splenectomy is opsi, also known as post splenectomy sepsis syndrome, which is defined as a generalized nonspecific flulike prodrome followed by rapid deterioration to fullblown fulminant septic shock within 2448 hours of the onset.
Asplenia and splenic dysfunction are associated with an immunodeficiency that predisposes patients to a lifethreating sepsis syndrome called. Reports of overwhelming postsplenectomy infection opsi began to. Increased risk for severe infections from bacteria such as streptococcus pneumoniae and neisseria meningitidis. Due to decreased response to encapsulated bacteria, the principal bacteria involved in postsplenectomy sepsis are primarily streptococcus pneumoniae 50% to 70%, and neisseria meningitidis and. Postsplenectomy and hyposplenic states antonio di sabatino, rita carsetti, gino roberto corazza the spleen is crucial in regulating immune homoeostasis through its ability to link innate and adaptive. Laparoscopic splenectomy is surgery to take out all or a part of your spleen. Pdf successful treatment of evans syndrome post liver. The utility of splenectomy as rescue treatment for severe acute antibody. Management of overwhelming postsplenectomy infection syndrome. According to the reasons for splenectomy, 14 patients with postsplenectomy hemorrhage were grouped into two groups. In individuals with neutropenia and felty syndrome who have recurrent lifethreatening bacterial infections, splenectomy is the treatment of choice, though the response is often short lived. Medical complications following splenectomy emconsulte.
It consists of a group of symptoms and signs such as. Opsi is a syndrome of fulminant sepsis occurring in. Evidencebased information on post splenectomy prophylaxis from hundreds of trustworthy sources for health and social care. Treatment of postsplenectomy thrombotic complications. Splenectomy is a surgical procedure to remove your spleen. What are other complications related to splenectomy. The most critical action in the treatment of opsi is the immediate use of broad spectrum i. Hematology a constellation of findings that follow splenectomy, which are most marked in the erythroid series, as the spleen is responsible for pitting and culling effete or. Partial splenectomy leaves behind role of splenectomy for.
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