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The pancreas is a retroperitoneal organ located at the level of the transpyloric plane. Descriptively it can be divided into the head, neck, body, and tail. It has several important anatomical relations, including the formation of the portal vein posteriorly. The main pancreatic duct drains secretions by combining with the common bile duct at the ampulla of Vater before opening into the duodenum via the major duodenal papilla. The pancreatic arterial supply is via the superior and inferior pancreaticoduodenal and splenic arteries. Acute pancreatitis is most commonly caused by gallstones and ethanol and can range in severity. Management focuses on symptom control, although interventions may be required for subsequent complications. Ductal adenocarcinoma accounts for over 85% of pancreatic neoplasms. The only curative treatment is surgical resection. The spleen lies within the left upper quadrant of the abdomen and is the largest lymphoid organ. Anatomically it can be divided into a superior and inferior pole, visceral and diaphragmatic surface, and superior, inferior, and intermediate borders. At the hilum, peritoneal reflections create two ligaments; the gastrosplenic and splenorenal. The blood supply is via the splenic artery and vein. Splenectomies can be considered in a variety of pathologies, including trauma, haematological conditions, and neoplasia. [ABSTRACT FROM AUTHOR]

Although postoperative portal vein thrombosis (PVT) is a frequent complication of splenectomy, few studies have examined PVT after simultaneous hepatectomy and splenectomy (HS). The aim of this study was to clarify the risk factors for and characteristics of PVT after HS. This retrospective observational study included 102 patients, including 76 with liver cirrhosis (LC) and 26 without, who underwent HS between April 2004 and April 2021. The incidence and location of postoperative PVT detected on contrast-enhanced CT 1 week after surgery were analyzed. In addition, pre- and intraoperative parameters were compared between patients with postoperative PVT and those without in order to determine risk factors for PVT after HS. Among the 102 patients, 29 (28.4 %), including 32.9 % with LC and 15.4 % without LC, developed PVT after surgery. Among the 29 patients with PVT, 21 (72.4 %), 4 (13.8 %), and 4 (13.8 %) developed thrombus in the intrahepatic portal vein only, extrahepatic portal vein only, and both the extra- and intrahepatic portal veins, respectively. Multivariable analysis showed that preoperative splenic vein dilatation was an independent risk factor for PVT after HS (odds ratio: 1.53, 95 % confidence interval: 1.156–2.026, P = 0.003). Our results suggest that splenic vein dilatation is an independent risk factor for PVT after simultaneous HS, and that PVT after HS occurs more frequently in the intrahepatic portal vein. After HS for cases with dilated splenic veins, we should pay particular attention to the PVT development in the intrahepatic portal vein regardless of the type of liver resection. [ABSTRACT FROM AUTHOR]

Introduction: Haemoperitoneum due to spontaneous splenic rupture is a rare condition. Methods: We present a case of AL-type amyloidosis and chronic kidney disease (CKD) who is presented with diffuse abdominal pain. A contrast-enhanced CT scan of the abdomen revealed moderate to large amounts of free fluid in the peritoneum, indicating splenic rupture causing haemoperitoneum. Result: The patient underwent emergency exploratory laparotomy and splenectomy. After the operation, the patient was closely monitored in the ICU and was transferred to the ward on postoperative day 3. He was discharged home on day 6. Conclusion: This case report highlights a rare occurrence of haemoperitoneum secondary to spontaneous splenic rupture in a patient with AL amyloidosis. [ABSTRACT FROM AUTHOR]

The spleen is a solid organ located beneath the left hemidiaphragm. Indications for surgical resection include trauma (blunt or penetrating), haematological diseases, abscesses, hydatid disease, oncological resection or immunosuppression. Surgical approaches include open, laparoscopic and, more recently, robotic; the complications of operative intervention will also be discussed. In patients with an absent spleen there is a significant increased risk of developing overwhelming post-splenectomy infection (OPSI). It is therefore essential to protect patients from infection due to encapsulated organisms through vaccination. This requires a combination of vaccinations, antibiotic prophylaxis and good education. [ABSTRACT FROM AUTHOR]

A mixed-breed, 8-year-old male dog developed neutropenia, thrombocytopenia, and hyperglobulinemia. Bone marrow hyperplasia and splenic plasmacytosis were cytologically observed. The dog had never been outside of Tokyo or Shizuoka Prefecture. Splenectomy was performed to confirm and remove the cause of splenic plasmacytosis. A histopathological diagnosis of splenic plasmacytoma was made; however, serum protein electrophoresis showed polyclonal gammopathy. Further screening was performed, and Ehrlichia canis infection was confirmed. The dog was treated with doxycycline for 5 weeks. After the antibiotic therapy, no relapse of neutropenia, thrombocytopenia, hyperglobulinemia, or positive polymerase chain reaction result of E. canis infection was observed for 3 years. Careful attention should be given to ehrlichiosis when exploring the cause of pancytopenia or hyperglobulinemia, regardless of the travel history. [ABSTRACT FROM AUTHOR]

There is an ongoing debate regarding the comparative merits of splenectomy (SP) and splenic preservation in the surgical management of gastric cancer. This systematic review and meta-analysis aims to shed light on potential differences in survival outcomes and postoperative complications associated with these two procedures. An exhaustive literature search was conducted across multiple databases, namely PubMed, Embase, Cochrane Library, and Web of Science. We utilized a random-effects model via RevMan 5.4 software to conduct a meta-analysis of the hazard ratios (HRs) and risk ratios (RRs) associated with SP and spleen preservation. Subgroup analyses were based on various attributes of the included studies. We employed funnel plots to assess publication bias, and sensitivity analysis was conducted to gauge the stability of the combined results. Both funnel plots and sensitivity analysis were performed using Stata 12. Our research incorporated 23 observational studies and three randomized controlled trials, involving a total of 6,255 patients. SP did not yield superior survival outcomes in comparison to splenic preservation, a conclusion that aligns with the combined results of the randomized controlled trials. No statistically significant difference in survival prognosis was observed between SP and splenic preservation, irrespective of whether the patients had proximal gastric cancer or proximal gastric cancer invading the stomach's greater curvature. SP exhibited a higher incidence of all postoperative complications, notably pancreatic fistula and intraabdominal abscesses. However, it did not significantly differ from splenic preservation in terms of anastomotic leakage, incision infection, intestinal obstruction, intra-abdominal bleeding, and pulmonary infection. No significant difference in postoperative mortality between SP and splenic preservation was found. Funnel plots suggested no notable publication bias, and sensitivity analysis affirmed the stability of the combined outcomes. Despite the lack of significant differences in certain individual complications and postoperative mortality, the broader pattern of our data suggests that SP is associated with a greater overall frequency of postoperative complications, without providing additional survival benefits compared to splenic preservation. Thus, the routine implementation of SP is not advocated. When doctors perform surgery for gastric (stomach) cancer, they sometimes remove the spleen, a procedure known as splenectomy (SP). However, there's a debate on whether removing the spleen is better than preserving it. Our study aimed to compare these two methods in terms of patient survival and the risk of complications after surgery. To do this, we looked at data from 26 studies involving 6,255 patients. Our analysis was thorough, using advanced statistical methods to ensure accuracy. Here's what we found: patients who had their spleen removed did not live longer than those who kept their spleen. Whether the cancer was just in the upper part of the stomach or had spread to the nearby large curve of the stomach, the survival rates were similar for both groups. Patients who underwent SP faced more postoperative complications, especially issues like pancreatic fistula and intra-abdominal abscesses. However, for some complications like leakage from the surgical joint, infection of the wound, bowel obstruction, internal bleeding, and lung infections, there was no significant difference between the two groups. The chances of dying post-surgery were similar whether patients had their spleen removed or not. Our findings suggest that routinely removing the spleen during gastric cancer surgery does not improve survival rates and is linked to more postoperative complications. Therefore, it may be better to avoid removing the spleen unless absolutely necessary. [ABSTRACT FROM AUTHOR]

Left-sided or segmental portal hypertension (SPHT) is a rare entity, most often associated with pancreatic disease or antecedent pancreatic surgery. The starting point is splenic vein obstruction secondary to local inflammation or, less often, extrinsic compression. SPHT leads to splenomegaly and development of collateral porto-systemic venous circulation. SPHT should be suspected in patients with pancreatic history who present with episodic upper gastrointestinal bleeding and splenomegaly with normal liver function tests. The most common clinical presentation is major upper gastrointestinal bleeding secondary to rupture of esophageal and/or gastric varices. At the present time, there are no management recommendations for SPHT, particularly when the patient is asymptomatic. In patients with upper gastro-intestinal bleeding, hemostasis can be obtained either by medical or interventional means according to patient status and available resources. For symptomatic patients, splenectomy is the reference treatment. Recently, less invasive, radiologic procedures, such as splenic artery embolization, have been developed as an alternative to surgery. Additionally, sonography-guided endoscopic hemostasis can also be envisioned, leading to the diagnosis and treatment of the lesion by elastic band ligation or by glue injection into the varices during the same procedure. The goal of this article is to describe the pathophysiological mechanisms behind SPHT and its clinical manifestations and treatment, based on a review of the literature. Because of the absence of recommendations for the management of SPHT, we propose a decisional algorithm for the management of SPHT based on the literature. [ABSTRACT FROM AUTHOR]

Children undergoing splenectomy for hemolytic anemia often have cholelithiasis, which may or may not be symptomatic. It is unclear whether concurrent cholecystectomy increases length of stay or morbidity after splenectomy. The purpose of this study was to compare morbidity among children undergoing laparoscopic splenectomy alone versus splenectomy with concurrent cholecystectomy in patients with hemolytic anemia. We retrospectively evaluated children with hemolytic anemia undergoing non-traumatic laparoscopic splenectomy in the National Surgical Quality Improvement Program-Pediatric database (2012–2020). Outcomes were compared for patients undergoing splenectomy alone (n = 1010) versus splenectomy with cholecystectomy (n = 371). Pearson's Chi-square and Student's t-tests were utilized as appropriate. Propensity score-matching was completed, controlling for eight demographic and clinical variables. 1381 patients were identified, 73.1% undergoing splenectomy alone and 26.9% splenectomy with cholecystectomy. Splenectomy with cholecystectomy patients were older (10.9 years vs. 8.4 years, p < 0.01), more likely to have hereditary spherocytosis (56.1% vs. 40.8%, p < 0.01), less likely to have sickle cell disease (12.1% vs. 33.5%, p < 0.01), more likely ASA class 1 or 2 (49.3% vs. 42.1%, p < 0.01), and had similar preoperative hematocrit levels (29.6 vs. 29.3, p = 0.33). The splenectomy with cholecystectomy group was less likely to receive preoperative blood transfusions (13.5% vs. 25.4%, p < 0.01). There were 360 pairs selected on propensity score-matching, and splenectomy with cholecystectomy was associated with increased operative time (182 min vs. 145 min, p < 0.01) and decreased occurrences of a postoperative transfusion (4.2% vs. 8.9%, p = 0.01). Length of stay after surgery (2.5 days vs. 2.3 days, p = 0.13), composite morbidity (3.9% vs. 3.4%, p = 0.69), and 30-day readmission rates (3.3% vs. 7.4%, p = 0.08) were all similar. Splenectomy with cholecystectomy is associated with similar postoperative morbidity, length of stay and readmission rates compared to splenectomy alone. These data support the safety of concurrent cholecystectomy with splenectomy for children with cholelithiasis in the setting of hemolytic anemia. Retrospective Cohort Study. Level III. [ABSTRACT FROM AUTHOR]

Whether congenital or acquired, wandering spleen is a rare entity. In most cases, surgical treatment necessitates splenectomy, or even more rarely, particularly in children, splenopexy. [ABSTRACT FROM AUTHOR]

Objective: Evaluate outcome of left-lobe graft (LLG) first combined with purely laparoscopic donor hemihepatectomy (PLDH) as a strategy to minimize donor risk. Background: An LLG first approach and a PLDH are 2 methods used to reduce surgical stress for donors in adult living donor liver transplantation (LDLT). But the risk associated with application LLG first combined with PLDH is not known. Methods: From 2012 to 2023, 186 adult LDLTs were performed with hemiliver grafts, procured by open surgery in 95 and PLDH in 91 cases. LLGs were considered first when graft-to-recipient weight ratio ≥ 0.6%. Following a 4-month adoption process, all donor hepatectomies, since December 2019, were performed laparoscopically. Results: There was one intraoperative conversion to open (1%). Mean operative times were similar in laparoscopic and open cases (366 vs 371 minutes). PLDH provided shorter hospital stays, lower blood loss, and lower peak aspartate aminotransferase. Peak bilirubin was lower in LLG donors compared with right-lobe graft donors (1.4 vs 2.4 mg/dL, P < 0.01), and PLDH further improved the bilirubin levels in LLG donors (1.2 vs 1.6 mg/dL, P < 0.01). PLDH also afforded a low rate of early complications (Clavien-Dindo grade ≥ II, 8% vs 22%, P = 0.007) and late complications, including incisional hernia (0% vs 13.7%, P < 0.001), compared with open cases. LLG was more likely to have a single duct than a right-lobe graft (89% vs 60%, P < 0.01). Importantly, with the aggressive use of LLG in 47% of adult LDLT, favorable graft survival was achieved without any differences between the type of graft and surgical approach. Conclusions: The LLG first with PLDH approach minimizes surgical stress for donors in adult LDLT without compromising recipient outcomes. This strategy can lighten the burden for living donors, which could help expand the donor pool. [ABSTRACT FROM AUTHOR]

Background: Gastrosplenic fistula (GSF) is a rare complication of various benign and malignant etiologies. Splenic lymphoma is the most common cause of GSF. Most cases are due to diffuse large B-cell lymphoma (DLBCL). Case presentation: A 39-year-old male patient presented at the emergency department with left upper quadrant abdominal pain. CT scan showed necrotic splenic mass with fistulous tract between the spleen and the gastric cavity. The patient underwent splenectomy and partial gastrectomy. The histopathological diagnosis was DLBCL. Conclusions: Gastrosplenic fistula is a rare complication of diffuse large B-cell lymphoma. Radiologists should be aware of it and consider it in the diagnosis. [ABSTRACT FROM AUTHOR]

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Background: Splenectomy is an established therapeutic intervention for benign haematological disorders (BHD) in children. Laparoscopic splenectomy (LS) has become accepted as the preferred alternative to the open procedure. The aim of this study was to evaluate the Hem-o-lok clips in controlling the splenic hilum during laparoscopic splenectomy in children as regards feasibility, safety, operative time, cost, and perioperative complications. Methods: This study included 27 cases with BHD, from April 2020 to December 2021, who underwent LS. In all patients, the Hem-o-lok clips were used to control the splenic pedicle. Operative time, intraoperative complications, need for conversion, and splenic extraction were reported. Postoperative course, complications, and hospital stay were also recorded. Patients were followed up for 3 months for development of complications and for evaluation of cosmetic appearance. Results: The mean operative time, excluding splenic extraction, was 67.04 min. There were 3 intraoperative minor bleeding incidents, all not related to Hem-o-lok application, and they were successfully controlled, with no need for conversion. The mean hospital stay was 1.3 days. We used one cartridge for each case (cost; 686 LE, US $28). Conclusions: The Hem-o-lok clips are feasible, safe, and cost effective in controlling the splenic hilum during LS in children with benign haematological diseases. [ABSTRACT FROM AUTHOR]

Gallstones are common in hereditary spherocytosis (HS) and other chronic hemolytic diseases, with most affected patients being asymptomatic. Whether and how asymptomatic gallstones should be treated is controversial. We conducted a retrospective cohort study of pediatric patients with HS and asymptomatic gallstones to compare the clinical outcomes between the observation group (followed up with gallstones in situ) and the intervention group (cholecystectomy or cholecystolithotomy). The primary outcome was the composite of adverse outcomes, including gallstone-associated, gallbladder surgery-associated, and splenectomy-associated events. Secondary outcomes included the changes in the size and number of gallstones and the recurrence of gallstones. Fifty-two patients were included (38 in the observation group and 14 in the intervention group), with a mean follow-up length of 5.2 years. Patients in the intervention group had a lower incidence of primary outcomes (7.1% vs. 42.1%) than patients in the observation group (OR, 0.12; 95%CI, 0.01–0.99). Patients with gallstones >5 mm in diameter had the highest risk of adverse events (47.4%). In the observation group, gallstone growth, disappearance, and stability were observed in 19.4%, 29.0%, and 51.6% of splenectomized HS patients, respectively. Small gallstones (diameter ≤5 mm) or sludge were more likely to be associated with disappearance (P = 0.04). Most asymptomatic gallstones grow or persist in splenectomized HS patients for an extended period. Surgical treatment of asymptomatic gallstones in HS patients requiring splenectomy is associated with a lower risk of adverse outcomes. III (retrospective comparative study). • What is currently known about this topic? • For HS patients without gallstones, prophylactic cholecystectomy is not recommended. For HS patients with symptomatic gallstones, cholecystectomy should be performed. • What new information is contained in this article? • Most asymptomatic gallstones would progress or persist in HS patients, yielding a high risk of gallstone-related adverse outcomes. Concomitant surgical procedures are encouraged. [ABSTRACT FROM AUTHOR]

Tuberculosis remains a major public health problem in developing countries. Isolated splenic tuberculosis is a rare form of extrapulmonary tuberculosis, with few cases documented in the literature, occurring mainly in immunocompromised individuals. The purpose of this article is to contribute to the medical knowledge regarding this rare disease and to highlight the diagnostic challenges and management approach. A 6-year-old immunocompetent child was admitted with febrile splenomegaly. Initial diagnostic evaluations, including imaging, suggested a possible diagnosis of lymphoma, prompting a laparoscopic splenectomy for diagnostic and therapeutic purposes. Histopathological examination of the splenic tissue revealed features consistent with tuberculosis, despite the absence of a detectable primary focus in the lungs or other organs. Postoperatively, the patient underwent a 6-month course of anti-tubercular therapy, with no recurrence observed during follow-up. Isolated splenic tuberculosis is an uncommon entity, particularly in immunocompetent individuals. The diagnosis is often challenging and delayed due to its nonspecific presentation, which can often mimic other conditions such as lymphoproliferative disorders, metastatic diseases, or other granulomatous diseases. Definitive diagnosis is based on histopathological analysis. Splenic tuberculosis, though rare in immunocompetent child, should be included in the differential diagnosis list of febrile splenomegaly, particularly in areas where tuberculosis is endemic. Early recognition and appropriate treatment are crucial to prevent complications and ensure favorable outcomes. • Isolated splenic tuberculosis is a rare form of extrapulmonary tuberculosis, with few cases documented in the literature particularly in immunocompetent children. • The diagnosis is often challenging and delayed due to its nonspecific clinical and radiological presentation. • Definitive diagnosis is based on histopathological analysis. • Early recognition and appropriate treatment are crucial to prevent complications and ensure favorable outcomes. [ABSTRACT FROM AUTHOR]

Sickle cell disease (SCD) patients encounter various complications, such as acute splenic sequestration crisis and hypersplenism that may require splenectomy. This systematic review and meta-analysis aims to clarify differences between total splenectomy (TS) or partial splenectomy (PS) in terms of hematological and postoperative outcomes. We identified studies involving SCD patients who underwent PS or TS, whether open or laparoscopic, and whose hematological and operative outcomes were evaluated, through searching PubMed, Web of Science, Scopus, Embase and Cochrane databases from inception until June 2024. Primary outcomes: hemoglobin concentration and reticulocytes %. Secondary outcomes: operative blood transfusion need, length of hospital stay (LoS), postoperative infections, overwhelming postsplenectomy sepsis (OPSS), acute chest syndrome (ACS), thromboembolic events and mortality. Eighteen studies were included; 17 cohort and one case series. Seven studies collected data from the same SICHA institutions, so a total of 756 SCD patients is included. According to the most recent study, no significant changes in hemoglobin (preoperative 10.5 ± 0.3 vs 9.6 ± 0.4 one year postoperative in 24 PS cases, and 9.7 ± 0.1 vs 9.7 ± 0.2 in 73 TS cases), however, both TS and PS significantly decreased reticulocyte by 2 % (0.8–3.2 %). Proportional analysis of short-term infection revealed a lower incidence in TS 2.71 % vs 8.64 % in PS, and similarly for ACS, it is 6.97 % in TS vs 14.90 % in PS. This first systematic review and meta-analysis shows that TS and PS have no or minimal effect on hemoglobin but a strong lowering effect on reticulocyte %. Proportional analysis reveals lower short-term infections and ACS following TS than PS. However, further clinical trials are necessary to draw definite conclusions and improve surgical decision making. Systematic review and meta-analysis of cohort studies. II. • No differences between TS and PS regarding hematological outcomes in SCD • Hemoglobin level is not changed after splenectomy in SCD • Both splenectomy types effectively reduce reticulocyte % in SCD • Less overall postoperative complications in total than partial splenectomy. [ABSTRACT FROM AUTHOR]

Evaluation of response to blood transfusion after blunt splenic injury (BSI) may prevent the need for splenectomy. The aim of this study was to evaluate factors associated with splenectomy in pediatric patients with isolated BSI who presented with hemodynamic instability with a focus on timing of transfusion. The 2021 Trauma Quality Improvement Project database was queried for children ≤18 years with BSI who arrived with a shock index>1.1. Interfacility transfer patients and those with additional intra-abdominal injuries were excluded. Demographic, injury characteristic and timing, transfusion, operative, and outcome data were collected. A sub-analysis of patients without brain injury was also performed. 516 patients met inclusion criteria; 60.1% were male, with mean age 12.3 ± 5.5 years. Initial mean shock index was 1.4 ± 0.4, ISS was 31.7 ± 15.1, and GCS was 10.7 ± 5. Splenectomy occurred in 27% of patients. Among splenectomy patients, 26.2% did not receive blood prior to splenectomy. While treatment at a pediatric trauma center showed an increased OR of splenectomy in univariable analysis, when controlling for lack of transfusion, no differences in splenectomy persisted. Patient Age (aOR-1.26, p < 0.001), BSI grade (aOR-2.30, P < 0.001), male gender, (aOR-2.2, p = 0.003), being non-white (aOR-2.0) ISS (aOR-1.03, p = 0.003), and GCS (aOR-0.95, p = 0.034) were associated with splenectomy. More than 26% of patients undergoing splenectomy did not receive blood prior to surgery. Differences in risk of splenectomy by center type seen on univariable analysis were not seen when controlling for transfusion. Evaluating response to blood transfusion may be an opportunity to reduce the frequency of splenectomy. Treatment Study Level III. [ABSTRACT FROM AUTHOR]

Spontaneous splenic rupture (SSR) is a rare, life-threatening complication, sometimes associated with infections like malaria and dengue fever. This case report details a unique presentation of SSR. A 28-year-old male in Somalia presented with fever, epigastric pain, nausea, vomiting, and body aches, consistent with malaria and dengue. Following self-discharge after initial malaria treatment, his condition deteriorated rapidly, leading to severe abdominal pain and hypotension. Laboratory tests confirmed malaria and dengue, with low hemoglobin. A CT scan revealed a large hemoperitoneum and splenic rupture requiring emergency laparotomy and splenectomy. Post-operative recovery was uneventful. This case highlights the diagnostic challenges posed by overlapping symptoms of malaria and dengue, potentially masking SSR. The concurrent infections likely contributed to splenomegaly, increasing rupture risk. While SSR has been linked to malaria or dengue individually, this case suggests a potential synergistic effect of co-infection. The patient's self-discharge emphasizes the importance of patient education and treatment adherence. Successful surgical intervention underscores the critical role of prompt medical care. This is the first reported case of SSR secondary to concurrent Plasmodium falciparum malaria and dengue fever in Somalia. This highlights the need for improved diagnostic tools, healthcare infrastructure, and targeted public health interventions in endemic regions. Further research is crucial to understand the synergistic effect of these co-infections in inducing SSR. • Rarity: The case represents a rare event, particularly the combination of both infections leading to SSR, and the first such reported case in Somalia. • Diagnostic Challenge: The initial presentation mimicked the symptoms of both malaria and dengue, delaying diagnosis and highlighting the difficulty in differentiating SSR from other acute abdominal conditions. • Synergistic Effect: The study suggests a potential synergistic effect of the co-infection in increasing the risk of splenic rupture, emphasizing the importance of considering this complication in such cases. • Successful Management: Despite the initial delay, prompt surgical intervention led to a successful outcome, highlighting the importance of timely diagnosis and appropriate treatment. • Policy Implications: The case underscores the need for improved diagnostic capabilities, enhanced healthcare infrastructure, effective public health interventions, patient education, and further research into the interplay between these infections and the risk of SSR. [ABSTRACT FROM AUTHOR]

Splenic infarction caused by thrombi rarely causes abdominal pain in acute abdomen patients. This report describes a case of splenic infarction caused by thrombus detachment due to paroxysmal atrial fibrillation, which was successfully treated and discharged from the hospital. A 52-year-old woman walked into the emergency room with left upper abdominal pain, nausea, and vomiting 12 h prior. Abdominal examination revealed tenderness in the left upper abdomen, with no palpable mass, rebound tenderness, or guard stiffness. Initial treatment included fasting and analgesia, as well as relevant auxiliary examinations. Intravenous contrast computed tomography (CT) revealed splenic branch artery obstruction with a large splenic infarction, and further examination with 24-h dynamic electrocardiogram monitoring revealed rapid atrial fibrillation. Five days after admission, because there was no significant improvement in her abdominal pain after fasting, fluid replacement, analgesia, etc., she was finally given a laparotomy with total splenectomy. In general, most surgeons do not advocate surgical intervention for splenic infarction, as infarction can lead to autologous splenectomy, and the spleen gradually becomes fibrotic, atrophies, and eventually disappears. However, for patients whose atrial fibrillation episodes continue to increase and whose conservative treatment is still ineffective, surgery provides a more favorable treatment method. This case report highlights that in patients with splenic infarction due to cardiac thrombosis and unrelieved abdominal pain, splenectomy can be considered if cardiac function is stable and tolerable and if the ASA anesthetic is below class V. • This report presents the first case of undergoing total splenectomy due to splenic infarction due to latent AF. • A thorough preoperative evaluation of the patient's medical history is key to diagnosing this condition. • Surgical intervention may be considered for patients with splenic infarction who do not respond to conservative treatment. • After surgery for splenic infarction, patient recovery is remarkable. [ABSTRACT FROM AUTHOR]

Wandering spleen, also known as ectopic spleen, is an uncommon disorder in which the spleen's anatomical location differs from its fixed position in the abdomen's left upper quadrant. The etiology is either congenital or acquired, possibly leading to torsion and splenic infarction. It affects children and young adults, especially childbearing-age women. Patients affected by this condition may present with nonspecific symptoms requiring a high index of suspicion. Given the nonspecific clinical symptoms and the potential complications associated with wandering spleen, computed tomography scans provide a crucial means for proper diagnosis. A 38-year-old female patient presented with worsening abdominal pain of one-week duration. The pain was more localized to the left hemi abdomen but later she claimed that it became diffuse. She had associated vomiting of ingested matter and loss of appetite. She had a similar complaint of abdominal pain for the last year. Up on examination, she looked acutely sick. Abdominal examination showed a flat abdomen moved with respiration; a big intra-abdominal mass was tender; it was freely mobile in all directions; with no sign of fluid collection. A CT scan of the abdomen suggested an ectopic spleen with splenic torsion. Intraoperative findings revealed an infarcted wandering spleen. An emergency splenectomy was performed. The patient was discharged on the third postoperative day and had an uneventful postoperative recovery. If a normal spleen is not identified in the left upper quadrant, a search for ectopic splenic tissue should ensue. If the patient has not had a prior surgical splenectomy, some possible explanations include an ectopic or "wandering" spleen. This case was an infarcted wandering spleen caused by abnormal ligamentous attachments. Wandering spleen with torsion poses a great diagnostic challenge for acute abdomen due to the rarity of its occurrence and non-specific presentations. A high index of suspicion is the key to early diagnosis and timely intervention is required to improve treatment outcomes. • Wandering spleen, also known as ectopic spleen, is an uncommon disorder in which the spleen's anatomical location differs from its fixed position in the abdomen's left upper quadrant. • Wandering spleen with torsion poses a great diagnostic challenge for acute abdomen due to the rarity of its occurrence and non-specific presentations. • Splenopexy and splenectomy are two alternatives for treatment in these patients, and the preferred alternative depends on the patient's age, vascular status, and size of the spleen [ABSTRACT FROM AUTHOR]

Wandering spleen or hypermobile spleen results from the elongation or maldevelopment of the spleen's suspensory ligaments. Few cases have been reported worldwide, making it a rare clinical entity. It usually affects children, although it also commonly affects female adults in the reproductive age range. A 30-year-old para 2 female patient presented with left upper quadrant abdominal pain of 3 days duration. She gave birth to a living baby 4 months before her current presentation. Her abdomen was distended, and there was a palpable mass on the central abdomen area. CT showed absence of spleen in the splenic fossa anterior to the left kidney, a wandering spleen with no attachment, and a whirl sign. The patient was managed with splenectomy and autotransplantation. Wandering spleen is one of the rare surgical conditions. The majority of affected females are multiparous, and women between the ages of 20 and 40 are approximately 13 times more likely than men to present with this condition. Ligamentous laxity of the spleen can be caused by physiologic splenomegaly and hormonal changes during pregnancy. Wandering spleen associated with splenomegaly is a rare clinical condition. These patients require a cautious approach due to the hypermobile spleen's propensity for torsion and infarction. • Wandering spleen is a rare clinical condition with an incidence of 0.2% • Most commonly affected demographics are children and women between ages 20 and 40 years • Its frequent correlation with pregnancy and postpartum is said to be caused by hormonal fluctuations and physiological changes • Treatment is almost always surgical. Splenectomy is the preferred in case of splenic pedicle torsion and subsequent infarction. [ABSTRACT FROM AUTHOR]

Splenic hilar lymphadenectomy is not recommended for advanced proximal gastric cancer that does not invade the greater curvature according to the results of the previous studies. The efficacy of splenic hilar lymphadenectomy for type II and type III adenocarcinomas of the esophagogastric junction and easy spread to the greater curvature of the stomach remains unclear. This study aimed to investigate the efficacy of splenic hilar lymphadenectomy and identify the risk factors for metastasis to splenic hilar nodes. We examined patients who underwent R0/1 gastrectomy for Siewert types II and III at a single high–volume center in Japan. We analyzed the metastatic incidence, therapeutic value index, and risk factors for splenic hilar lymph node metastasis. We examined 126 patients (74, type II; 52, type III). Splenectomy was performed in 76 patients. Metastatic incidence and the therapeutic value index of splenic hilar lymph nodes in patients with type II and type III tumors were 4.5% and 0, and 21.9% and 9.4, respectively. In the patients who underwent splenectomy, we identified Siewert type III tumors (odds ratio: 6.93, 95% confidence interval: 1.24–38.8, p = 0.027) and tumor location other than the lesser curvature (odds ratio: 7.36, 95% confidence interval: 1.32–41.1, p = 0.023) to be independent risk factors. The metastatic incidence (46.2%) and therapeutic value index (15.4) were high in patients with both risk factors. Splenic hilar lymphadenectomy may contribute to the survival of patients with Siewert type III tumors, especially when the predominant location is not the lesser curvature. [ABSTRACT FROM AUTHOR]

Spontaneous hemangiosarcoma in guinea pigs has only been reported twice in the literature. This study aims to better characterize the prevalence, clinical presentation, treatment, and outcome of this rare disease in guinea pigs. Medical records (2007–2021) from four referral centers were reviewed. Guinea pigs with a histopathological diagnosis of hemangiosarcoma performed by a board certified veterinary pathologist were selected for inclusion. Of 3994 guinea pigs examined, five were included in the study. The median age at the time of diagnosis was four years (4–6 years). Four of the five patients presented with dysorexia. An abnormal spleen was palpated in all animals and confirmed by ultrasonography. Only one guinea pig had presurgical radiographs to evaluate for metastasis before splenectomy. One patient was euthanized after surgery, while the others died two weeks, six months, 15 months and 49 months after the procedure. One patient was also treated with Trametes versicolor extracts as an adjuvant antineoplastic therapy. The median survival time was six months. Abdominal palpation and ultrasound can provide a presumptive diagnosis of splenic enlargement. Splenectomy has proven to be a feasible surgical procedure for the treatment of splenic hemangiosarcoma, potentially combined with adjuvant anticancer therapies. The variable survival after splenectomy reported in the five cases here is challenging to interpret because of the different anesthetic techniques and comorbidities. Further research is needed to improve understanding of the biological behavior of this neoplasm as well as the benefits of splenectomy and adjuvant therapies. [ABSTRACT FROM AUTHOR]

PIPAC (Pressurized IntraPeritoneal Aerosol Chemotherapy) is a minimally invasive approach relying on physical principles for improving intraperitoneal drug delivery, including optimizing the homogeneity of drug distribution through an aerosol. Feasibility and safety of the new approach are now consolidated and data on its effectiveness are continuously increasing. Although any surgical procedure associated with PIPAC had always been discouraged due to the high risk of complications, surgical practice is constantly changing: with growing expertise, more and more surgical teams associate PIPAC with surgery. PLUS study is part of the retrospective international cohort studies including 10 centers around the world (India, Italy, France, Germany, Belgium, Russia, Saudi Arabia, Switzerland) and 96 cases of combined approaches evaluated through a propensity score analysis. the procedures most frequently associated with PIPAC were not only adhesiolysis, omentectomy, adnexectomy, umbilical/inguinal hernia repairs, but also more demanding procedures such as intestinal resections, gastrectomy, splenectomy, bowel repair/stoma creation. Although the evidence is currently limited, PLUS study demonstrated that PIPAC associated with additional surgical procedures is linked to an increase of surgical time (p < 0.001), length of stay (p < 0.001) and medical complication rate (p < 0.001); the most frequently reported medical complications were mild or moderate in severity, such as abdominal pain, nausea, ileus and hyperthermia. No difference in terms of surgical complications was registered; neither reoperation or postoperative deaths were reported. these results suggest that PIPAC can be safely combined in expert centers with additional surgeries. Widespread change of practice should be discouraged before the results of ongoing prospective studies are available. [ABSTRACT FROM AUTHOR]

Wandering spleen (WS), characterized by abnormal mobility due to laxity of its ligaments, is a rare condition often presenting diagnostic challenges. Its complications, such as torsion and infarction, necessitate prompt recognition and management to prevent life-threatening outcomes. We report a case of a 45-year-old female presenting with acute abdominal pain, constipation, and a palpable mass in the right iliac fossa. Imaging revealed a torsion of a wandering spleen, a rare occurrence exacerbated by delayed diagnosis despite a decade of symptoms. Diagnostic imaging, including abdominal ultrasound and CT scan, played a crucial role in confirming the ectopic spleen and guiding surgical intervention. Immediate laparotomy revealed a twisted spleen necessitating splenectomy due to non-viability post-detorsion attempt. This case underscores the importance of considering wandering spleen in the differential diagnosis of acute abdominal pain, especially in patients with chronic intermittent symptoms. Surgical intervention remains the definitive treatment, emphasizing the risks associated with conservative management in preventing complications. • Rare case of torsion of a wandering spleen in a 45-year-old female, underscores the challenges of diagnosing a rare condition with non-specific symptoms over a prolonged period. • Successful open splenectomy performed following 1440° clockwise torsion and unsuccessful detorsion attempt. • Emphasis on the diagnostic role of imaging (CT scan) in identifying ectopic spleen and guiding surgical intervention. • Importance of clinical suspicion for wandering spleen in patients with chronic abdominal symptoms. • Surgical management as the gold standard due to high risk of complications with conservative approaches. [ABSTRACT FROM AUTHOR]

Background This case report details a 57-year-old African American man with pancreatic neuroendocrine tumors (NETs). The patient underwent positron emission tomography (PET) imaging using gallium Ga 68 dotatate, which localized the tumors. Selected tumors were treated with 4 doses of 200 mCi of lutetium Lu 177 dotatate during a period of 8 months. At the conclusion of treatment, the patient demonstrated improvement, progressing from bedbound and confused to ambulatory and coherent. In addition, the patient stated he felt no adverse effects. Discussion Pancreatic NETs are rare tumors affecting 0.001% of the population. These tumors are associated with various symptoms and are classified as functional or nonfunctional. Imaging modalities, such as computed tomography (CT), magnetic resonance (MR) imaging, and gallium Ga 68--labeled PET, are essential in detecting and evaluating pancreatic NETs. For patients with localized NETs, the primary treatment is surgery; however, the radiopharmaceuticals yttrium Y 90 microspheres and lutetium Lu 177 dotatate are used as therapy to treat nonresectable tumors. Conclusion Lutetium Lu 177 dotatate is used in NET cases that are deemed inoperable and for patients who are not responding to treatment. This case study demonstrates the effectiveness of combining imaging with Ga 68--labeled PET and treatment with lutetium Lu 177 dotatate. This treatment is not a cure but has been shown to improve a patient's quality of life. [ABSTRACT FROM AUTHOR]

Portal hypertension due to cirrhosis is common among patients with hepatocellular carcinoma (HCC). This study aimed to compare the outcomes of partial hepatectomy in patients with HCC and clinically significant portal hypertension (CSPH) with or without concurrent splenectomy and esophagogastric devascularization (CSED). From a multicenter database, patients with HCC and CSPH who underwent curative-intent hepatectomy were identified. Postoperative morbidity and mortality, and long-term overall survival (OS) were compared in patients with and without CSED before and after propensity score matching (PSM). Of the 358 enrolled patients, 86 patients underwent CSED. Before PSM, the postoperative 30-day morbidity and mortality rates were comparable between the CSED and non-CSED group (both P > 0.05). Using PSM, 81 pairs of patients were created. In the PSM cohort, the 5-year OS rate of the CSED group were significantly better than the non-CSED group (52.9% vs. 36.5%, P = 0.046). The former group had a significantly lower rate of variceal bleeding on follow-up (7.4% vs. 21.7%, P = 0.014). On multivariate analysis, CSED was associated with significantly better OS (HR: 0.39, P < 0.001). Hepatectomy and CSED can safely be performed in selected patients with HCC and CSPH, which could improve postoperative prognosis by preventing variceal bleeding, and prolonging long-term survival. [ABSTRACT FROM AUTHOR]

Pelvic splenosis, also called ectopic pelvic spleen, is a rarely reported clinical condition. Pelvic splenosis refers to autotransplantation of splenic tissue resulting from seeding into the pelvic space that typically occurs after trauma. This report presents the case of a 39-year-old male with a rectal lesion. After a laparoscopic low anterior resection of rectosigmoid colon with colorectal anastomosis, the lesion was resected and diagnosed as an ectopic pelvic spleen. Pelvic splenosis requires no treatment in most cases. Surgery is considered only if it is accompanied with acute complications. When the diagnosis remains unclear, further biopsy or laparoscopy is recommended. If pelvic splenosis is confirmed, careful follow-up is beneficial. Finally, pelvic splenosis should be considered in the differential diagnosis of pelvic masses in patients with a history of splenectomy. [ABSTRACT FROM AUTHOR]

Although thrombocytopenia is common in end-stage liver disease, severe, refractory thrombocytopenia during liver transplantation is rare, and if immune based, usually presents months or years later. This case describes an adult woman in whom preoperative evaluation had not determined an immune-related cause of thrombocytopenia. Clot strength was dramatically impaired as measured by thrombelastography during the transplant. Following a lack of response to repeat platelet transfusions, splenectomy was performed after graft reperfusion with rapid temporal restoration of clot strength. This case shows a severe manifestation of perioperative thrombocytopenia during liver transplantation and clinically guided management when measured clot strength is too low for accurate determination. [ABSTRACT FROM AUTHOR]

Postoperative posterior reversible encephalopathy syndrome has seldom been reported in the pediatric age group. We describe this syndrome in a child of hereditary spherocytosis who underwent splenectomy for hypersplenism. [ABSTRACT FROM AUTHOR]

• In cases of splenic trauma with hemodynamic stability, rate of splenic salvage is a major criterium for evaluation of the different practices (surveillance, radiological embolization or conservative surgery). • Taking into account recent advances in interventional radiology, some centers propose preventive embolization for the patients most at risk of secondary rupture, mainly those with grade IV–V trauma according to the American Association for the Surgery of Trauma classification. • The multicenter SPLASH randomized trial involved 133 stable patients at high risk of splenic rupture and compared the results of early preventive embolization with those of ulteriorly necessary embolization. While systematic embolization was not linked to heightened splenic salvage rate, it was associated with reduced length of hospital stay. The overall rate of SAE-related complications was 6%. • These results justify the proposal of prophylactic embolization in cases of OIS Grade IV–V splenic injury with hemodynamic stability. [ABSTRACT FROM AUTHOR]