Mishin Igor, Ghidirim Gheorghe
First Department of Surgery N.Anestiadi and Laboratory of Hepato-Pancreato-Biliary Surgery, Emergency Municipal Hospital, Medical University N.Testemitsanu, Kishinev, Moldova.
Surg Today. 2004;34(12):1044-8. doi: 10.1007/s00595-004-2837-y.
We report a case of recurrent thrombocytopenia associated with symptomatic enlargement of an accessory spleen, 2 years after splenectomy, in a 36-year-old man with posthepatitic liver cirrhosis. The patient suffered three episodes of variceal bleeding, but the esophageal varices were not eradicated by two sessions of endoscopic injection sclerotherapy and endoscopic band ligation. Abdominal ultrasonography and computed tomography showed a giant accessory spleen (6 x 6 x 5 cm), gallbladder stones, and complete postsplenectomy splenomesoportal thrombosis. Subsequent 99mTc scintigraphy confirmed the presence of a functioning residual splenic nodule. Thus, we performed gastroesophageal devascularization (Hassab-Paquet procedure) with accessory splenectomy and cholecystectomy, after which the platelet count normalized and no further variceal bleeding occurred during 17 months of follow-up. To our knowledge, this is the first report in the English medical literature of accessory splenectomy for recurrent thrombocytopenia in a patient with liver cirrhosis.
我们报告一例36岁患有肝炎后肝硬化的男性患者，在脾切除术后2年出现复发性血小板减少症并伴有副脾有症状性增大。该患者发生了3次静脉曲张出血，但经两次内镜注射硬化疗法和内镜下套扎术均未根除食管静脉曲张。腹部超声和计算机断层扫描显示有一个巨大的副脾（6×6×5cm）、胆囊结石以及脾切除术后完全性脾门-门静脉血栓形成。随后的99mTc闪烁扫描证实存在一个有功能的残余脾结节。因此，我们实施了胃食管去血管化术（哈萨布-帕凯手术），同时切除副脾和胆囊，术后血小板计数恢复正常，在17个月的随访期间未再发生静脉曲张出血。据我们所知，这是英文医学文献中首例关于肝硬化患者因复发性血小板减少症而行副脾切除术的报道。
