Although the clinical benefit of laparoscopic splenectomy and devascularization(LSD) has been elaborated in many studies,its application in massive splenomegaly remains controversial.We conducted a retrospective resea...Although the clinical benefit of laparoscopic splenectomy and devascularization(LSD) has been elaborated in many studies,its application in massive splenomegaly remains controversial.We conducted a retrospective research to assess the curative efficacy of LSD for massive splenomegaly due to portal hypertension.Forty-seven patients with massive splenomegaly due to portal hypertension were enrolled in this study,and divided into two groups.Twenty-one patients underwent open splenectomy and devascularization(OSD) from June 2010 to October 2012(OSD group).From March 2013 to February 2015,LSD was performed on 26 patients(LSD group).Perioperative variables were analyzed.Compared to OSD,LSD was associated with less blood loss(241.9±110.0 m L vs.319.0±139.5 m L,P<0.05),more rapid resumption of oral diet(2.46±0.95 days vs.3.76±1.09 days,P<0.05),and shorter postoperative hospital stay(5.35±1.65 days vs.7.24±1.55 days,P<0.05).It was concluded that for patients with massive splenomegaly due to portal hypertension,LSD is feasible and as safe as OSD.展开更多
BACKGROUND The most effective treatment for advanced cirrhosis and portal hypertension is liver transplantation(LT).However,splenomegaly and hypersplenism can persist even after LT in patients with massive splenomegal...BACKGROUND The most effective treatment for advanced cirrhosis and portal hypertension is liver transplantation(LT).However,splenomegaly and hypersplenism can persist even after LT in patients with massive splenomegaly.AIM To examine the feasibility of performing partial splenectomy during LT in patients with advanced cirrhosis combined with severe splenomegaly and hypersplenism.METHODS Between October 2015 and February 2019,762 orthotopic LTs were performed for patients with end-stage liver diseases in Tianjin First Center Hospital.Eighty-four cases had advanced cirrhosis combined with severe splenomegaly and hypersplenism.Among these patients,41 received partial splenectomy during LT(PSLT group),and 43 received only LT(LT group).Patient characteristics,intraoperative parameters,and postoperative outcomes were retrospectively analyzed and compared between the two groups.RESULTS The incidence of postoperative hypersplenism(2/41,4.8%)and recurrent ascites(1/41,2.4%)in the PSLT group was significantly lower than that in the LT group(22/43,51.2%;8/43,18.6%,respectively).Seventeen patients(17/43,39.5%)in the LT group required two-stage splenic embolization,and further splenectomy was required in 6 of them.The operation time and intraoperative blood loss in the PSLT group(8.6±1.3 h;640.8±347.3 mL)were relatively increased compared with the LT group(6.8±0.9 h;349.4±116.1 mL).The incidence of postoperative bleeding,pulmonary infection,thrombosis and splenic arterial steal syndrome in the PSLT group was not different to that in the LT group,respectively.CONCLUSION Simultaneous PSLT is an effective treatment and should be performed in patients with advanced cirrhosis combined with severe splenomegaly and hypersplenism to prevent postoperative persistent hypersplenism.展开更多
BACKGROUND Hand-assisted laparoscopic splenectomy(HALS) can help overcome the drawbacks of laparoscopic splenectomy(LS) while maintaining its advantages.AIM To evaluate the efficacy and advantages of HALS for splenome...BACKGROUND Hand-assisted laparoscopic splenectomy(HALS) can help overcome the drawbacks of laparoscopic splenectomy(LS) while maintaining its advantages.AIM To evaluate the efficacy and advantages of HALS for splenomegaly.METHODS The relevant literature was reviewed using the PubMed, EMBASE, Cochrane,Ovid Medline, and Wanfang databases to compare the clinical outcomes of HALS and LS. Odds ratios or mean differences were calculated with 95% confidence intervals for fixed-effects and random-effects models. Overall, 754 patients from16 trials who met the inclusion criteria were selected.RESULTS In pure splenectomy, blood loss volume(P < 0.001) and conversion rate(P =0.008) were significantly lower in the HALS group than in the LS group.Conversely, for splenomegaly, the operative time(P = 0.04) was shorter and blood loss volume(P < 0.001) and conversion rate(P = 0.001) were significantly lower in the HALS group than in the LS group. However, no significant difference was observed in hospital stay length, blood transfusion, time to food intake, complications, or mortality rate between the two groups. Moreover, in splenectomy and devascularization of the upper stomach(DUS), the operative time(P = 0.04) was significantly shorter and blood loss volume(P < 0.001) andconversion rate(P = 0.05) were significantly lower in the HALS + DUS group than in the LS + DUS group. However, no significant difference was observed in hospital stay length, timing of diet, and complications between the two groups.CONCLUSION HALS is an ideal surgical treatment method for splenomegaly because it can maximize the benefits for patients while maintaining the advantages of LS.展开更多
We report a case of a patient with Schistosoma mansoni infection who presented with liver cirrhosis and splenomegaly.She was diagnosed by a serological test and Kato-Katz thick smear stool examination.The patient was ...We report a case of a patient with Schistosoma mansoni infection who presented with liver cirrhosis and splenomegaly.She was diagnosed by a serological test and Kato-Katz thick smear stool examination.The patient was a 52-year-old woman from Sudan who came to Malaysia for a week to visit her sons.The patient lives in the middle of Rabak region,Sudan,a highly endemic area for schistosomiasis where her daily routine includes rearing of cows and farming.The site of toilet and sources of drinking water are canals and wells;both infested with snails.Patient had a long history of exposure and coming into contact with water from these canals and wells.展开更多
A 33-year-old primigravida presented to an appointment at a high-risk prenatal outpatient service due to a history of splenomegaly. Her spleen occupied of the abdominal cavity and shifted the uterus to the right side ...A 33-year-old primigravida presented to an appointment at a high-risk prenatal outpatient service due to a history of splenomegaly. Her spleen occupied of the abdominal cavity and shifted the uterus to the right side of the abdomen. During investigation, an intrauterine growth restriction (IURG) and a series of other clinical complications were discovered. We admitted her to inpatient care at 28 + 1 weeks’ gestation for a better investigation of her extensive splenomegaly and for pregnancy monitoring, with a further successful delivery.展开更多
Splenomegaly, sometimes of massive extent, occurs in a large number of hereditary diseases, some relatively prevalent and others, rare to ultra-rare. Because physicians are often unfamiliar with the less common disord...Splenomegaly, sometimes of massive extent, occurs in a large number of hereditary diseases, some relatively prevalent and others, rare to ultra-rare. Because physicians are often unfamiliar with the less common disorders, patients may suffer because of diagnostic delay or diagnostic error and may undergo invasive, non-innocuous procedures such as splenectomy that are potentially avoidable were the correct diagnosis suspected. In this review article, we discuss the definition and clinical ramifications of “massive” splenomegaly and describe several rare genetic disorders that are sometimes associated with marked splenic enlargement as well as four additional hereditary “splenomegalic” lysosomal storage diseases (cholesterol esterase storage disease, Niemann-Pick C disease, acid sphingomyelinase deficiency disease, Gaucher disease) in which approved or promising experimental treatments should generally obviate the need for palliative splenectomy. We also summarize current concepts about the appropriate use of splenectomy in patients with β-thalassemia, hereditary spherocytosis and Gaucher disease and discuss surgical alternatives to classical total splenectomy for these disorders.展开更多
Introduction: Sickle cell disease is the most common hemoglobinopathy in the world. Sickle cells are quickly fixed and destroyed by the elements of the reticuloendothelial system mainly in the spleen. It leads to a pa...Introduction: Sickle cell disease is the most common hemoglobinopathy in the world. Sickle cells are quickly fixed and destroyed by the elements of the reticuloendothelial system mainly in the spleen. It leads to a palpable increase in the volume of the spleen called splenomegaly. Splenomegaly is the cause of multiple complications that are relatively frequent and potentially serious in sickle cell disease, such as splenic sequestration seizures, spleen rupture, hypersplenism and splenic abscesses. We aimed at determining the prevalence of splenomegaly and to study the associated factors in patients with sickle cell disease. Materials and Methods: This was an analytical cross-sectional study, conducted from 1 January to 30 April 2019, at the Mother and Child Center of the Chantal BIYA Foundation. Patients were grouped into two groups: patients with splenomegaly (PS1) and patients without splenomegaly (PS0). As soon as we obtained the informed consent of the parents, we examined the children and recorded socio-demographic data, disease history and follow-up, documented complications, and clinical findings;then we performed the Rapid Malaria Diagnostic Test. The statistical analyzes were carried out using SPSS20 (Statistical Package for Social Sciences) and Microsoft Excel 2010 software. Results: We examined 403 children with sickle cell disease and 142 had splenomegaly (35%). Almost all of the study populations were homozygous SS. The Hackett 2 stage of splenomegaly was the most frequent (56.7%). The most common physical sign among PS1 was the presence of abdominal scarring (50.7% vs. 19.4%). PS1 had significantly lower levels of Hb (6.94 ± 1.67 vs 7.62 ± 1.43 p = 0.003) and platelets (297.45 ± 146.25 vs 398.70 ± 163.73 p < 0.001) than patients without splenomegaly (PS0). However, the percentages of HbF (21.78 ± 10.48 vs 15.66 ± 9.20 p < 0.001) and malaria infection (74.6% vs 17.2% p < 0.001) were statistically higher among PS0. Logistic regression analysis determined that the factors associated with splenomegaly were: malaria, high fetal hemoglobin, low hemoglobin S, hepatomegaly, thrombocytopenia and use of non-steroidal anti-inflammatory drugs. Conclusion: Splenomegaly is a frequent physical sign of sickle cell disease in children and factors associated are malaria, high hemoglobin F, low hemoglobin S, hepatomegaly, thrombocytopenia and NSAID use.展开更多
<strong>Background:</strong> Inhabitants from malaria endemic zones often present with enlarged spleen, mainly due to hyper reactive malarial splenomegaly (HMS), and it is seen more commonly associated wit...<strong>Background:</strong> Inhabitants from malaria endemic zones often present with enlarged spleen, mainly due to hyper reactive malarial splenomegaly (HMS), and it is seen more commonly associated with elevated levels of Immunoglobulin M (IgM). Cold agglutinin disease is an acquired autoimmune hemolytic anemia (AIHA) that is usually due to cold-reacting IgM autoantibodies directed against red cell antigens. The study was conducted in response to the observed high frequency of transfusion dependent anemia in patients with splenomegaly from malaria endemic zones in southern province of Rwanda. The objectives of this study were to determine the prevalence of cold agglutinin disease and to assess the distribution of IgM antibodies among these patients. <strong>Methodology:</strong> This was a descriptive, cross-sectional study conducted over a period of six months from June 2016 to December 2016. The study enrolled adult population from malaria endemic areas of the southern province of Rwanda with unexplained splenomegaly. Blood samples for testing IgM levels, cold agglutinin, FBC, and markers of hemolysis were collected from peripheral health settings and analyzed at the laboratory of Butare University Teaching Hospital. <strong>Results:</strong> During the study period, we enrolled 188 participants with enlarged spleen. One hundred twenty-five (66%) were females and 34% were males. The mean (±SD) age of the study participants was 35.6 ± 15.2 years. Out of 188 participants, only 4.8% were found with significantly positive Cold Agglutinin Titer (CAT) (≥1:64) and 84% of participants were found to have elevated serum IgM level. Hemoglobin level, white blood count and platelets count decrease with severity of splenomegaly, while IgM level increases with spleen size. <strong>Conclusion:</strong> Among patients with splenomegaly from malaria endemic areas, IgM levels correlate with the stages of splenomegaly while cold agglutinin disease plays a small role in the etiology of anemia.展开更多
Objective:To establish the modulatory effects of coenzyme Q_(10)on experimental trypanosome infections in mice and evaluate the risk of occurrence and severity of melarsoprol-induced post treatment reactive encephalop...Objective:To establish the modulatory effects of coenzyme Q_(10)on experimental trypanosome infections in mice and evaluate the risk of occurrence and severity of melarsoprol-induced post treatment reactive encephalopathy(PTRE).Methods:Female Swiss white mice were orally administered with 200 mg/kg of coenzyme Q_(10)after which they were intraperitoneally inoculated with Trypanasoma brucei rhodesiense(T.b.rhodesiense).The resultant infection was allowed to develop and simulate all phases of human African trypanosomiasis and PTRE.Parasitaemia development,packed cell volume,haematological and pathological changes were determined.Results:A histological study in the brain tissue of T.b.rhodesiense infected mice demonstrated neuroinflammatory pathology which was highly amplified in the PTRE-induced groups.A prominent reduction in the severity of the neuroinflammatory response was detected when coenzyme-Q_(10)was administered.Furthermore,the mean tissue weight of spleen to body ratio in coenzyme Q_(10)supplemented group was significantly(P<0.05)different compared to un-supplemented groups,and clearly indicated that coenzyme Q_(10)prevented full blown splenomegaly pathogenesis by T.b.rhodesiense.A significant(P<0.05)increase in hemoglobin levels and red blood cells was observed in coenzyme Q_(10)mice compared to those infected and un-supplemented with coenzyme Q_(10).Conclusions:The capacity of coenzyme Q_(10)to alter the pathogenesis of T.b.rhodesiense infection in mice and following treatment with melarsoprol,may find application by rendering humans and animals less susceptible to deleterious effects of trypanosome infection such as splenomegaly and melarsoprol-induced PTRE and neurotoxicity.展开更多
Niemann-Pick disease (NPD) refers to a group of patients who have varying degrees of lipid storage and foam cell infiltration in tissues, as well as overlapping clinical features, including hepatosplenomegaly, insuffi...Niemann-Pick disease (NPD) refers to a group of patients who have varying degrees of lipid storage and foam cell infiltration in tissues, as well as overlapping clinical features, including hepatosplenomegaly, insufficiency pulmonary and/or central nervous system (CNS). Thanks to the pioneering work of Roscoe Brady and colleagues, we now know that there are two distinct metabolic abnormalities that explain NPD. The first is due to the deficient activity of the acid sphingomyelinase enzyme (ASM;NPD “types A and B”), and the second is due to defective functioning in the transport of cholesterol (NPD “type C”). We report the case of a 13-year-old adolescent diagnosed with Niemann-Pick A/B disease.展开更多
Since early 1990's,when it was inaugurally introduced,laparoscopic splenectomy has been performed with excellent results in terms of intraoperative and postoperative complications.Nowadays laparoscopic splenectomy...Since early 1990's,when it was inaugurally introduced,laparoscopic splenectomy has been performed with excellent results in terms of intraoperative and postoperative complications.Nowadays laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen.However some contraindications still apply.The evolution of the technology has allowed though,cases which were considered to be absolute contraindications for performing a minimal invasive procedure to be treated with modified laparoscopic approaches.Moreover,the introduction of advanced laparoscopic tools for ligation resulted in less intraoperative complications.Today,laparoscopic splenectomy is considered safe,with better outcomes in comparison to open splenectomy,and the increased experience of surgeons allows operative times comparable to those of an open splenectomy.In this review we discuss the indications and the contraindications of laparoscopic splenectomy.Moreover we analyze the standard and modified surgical approaches,and we evaluate the short-term and long-term outcomes.展开更多
A littoral cell angioma(LCA) is a primary vascular tumor of the spleen, that can have malignant potential and may present association with other malignancies. This is a case of LCA that was discovered incidentally in ...A littoral cell angioma(LCA) is a primary vascular tumor of the spleen, that can have malignant potential and may present association with other malignancies. This is a case of LCA that was discovered incidentally in a 79-year-old woman who presented with a polycythemia at the time of consultation. The neoplasm was evaluated by ultrasound and computed tomography. The patient underwent a splenectomy that revealed LCA by pathological evaluation. The post-operative outcome was favorable with no complications or recurrent disease. This case presentation, clinical, radiographic, and pathological features of an uncommon splenic tumor can be studied in order to advance our knowledge in our understanding of LCA.展开更多
Primary histiocytic sarcoma of the spleen is a rare but potentially lethal condition. It can remain asymptomatic or only mildly symptomatic for a long time. An 81-year-old woman presented with an extremely enlarged sp...Primary histiocytic sarcoma of the spleen is a rare but potentially lethal condition. It can remain asymptomatic or only mildly symptomatic for a long time. An 81-year-old woman presented with an extremely enlarged spleen. She suffered from progressive anemia and required a red blood cell transfusion once a month. Although computed tomography, ultrasonography, and magnetic resonance imaging were performed for diagnosis, a confirmed diagnosis was not obtained. Her enlarged spleen compressed her stomach, and she suffered from gastritis and a sense of gastric fullness just after meals. She underwent laparoscopic splenectomy for therapeutic and diagnostic purposes. Her postoperative course was uneventful. After surgery, her red blood cell and platelet counts increased markedly. The tumor was diagnosed as splenic histiocytic sarcoma. Post-surgical chemotherapy was not performed, and the patient died of liver failure due to liver metastasis 5 mo after surgery. Laparoscopic splenectomy is minimally invasive and useful for the relief of symptoms related to hematological disorders. However, in cases of an enlarged spleen, optimal views and working space are limited. In such cases, splenic artery ligation can markedly reduce the size of the spleen, thus facilitating the procedure. The case reported herein suggests that laparoscopic splenectomy may be useful for the treatment of splenic malignancy.展开更多
BACKGROUND Primary liver cancer is one of the most common malignant tumours,while primary splenic lymphoma is a rare malignancy.Thus,cases of hepatocellular carcinoma(HCC)combined with splenic lymphoma are extremely r...BACKGROUND Primary liver cancer is one of the most common malignant tumours,while primary splenic lymphoma is a rare malignancy.Thus,cases of hepatocellular carcinoma(HCC)combined with splenic lymphoma are extremely rare.CASE SUMMARY We present a 62-year-old woman who was admitted to the Interventional Radiology Department with a lump in the spleen and liver as well as multiple enlarged lymph nodes visible by ultrasound.Contrast-enhanced computed of the abdomen revealed a circular,low-density,shallow mass(approximately 2.6 cm in diameter)in the left intrahepatic lobe and multiple round,low-density shadows in the spleen with clear boundaries(maximum diameter 7.6 cm).Based on the characteristic clinical symptoms and explicit radiological findings,the clinical diagnosis was HCC with metastasis to the liver portal,retroperitoneal lymph nodes,and spleen.After transcatheter arterial chemoembolization and sequential radiofrequency ablation,the-fetoprotein level returned to the normal range,and the hepatitis B cirrhosis improved.In addition,splenic tumour biopsy confirmed the diagnosis of primary malignant lymphoma,which went into remission after chemotherapy.CONCLUSION HCC with primary splenic non-Hodgkin lymphoma is extremely rare and easily misdiagnosed.Better understanding would facilitate early diagnosis,treatment and prognosis.展开更多
A 57-year-old female was admitted with pancytopenia, and mild splenomegaly. The multiple myeloma diagnosis was wrongly made since the discovery of monoclonal peak to the protein electrophoresis. Further microscopic ex...A 57-year-old female was admitted with pancytopenia, and mild splenomegaly. The multiple myeloma diagnosis was wrongly made since the discovery of monoclonal peak to the protein electrophoresis. Further microscopic examination of bone marrow revealed the accumulation of sea-blue histiocytes. The evolution was stable and the patient did not receive any treatment due to the lack of nervous symptoms.展开更多
Importance of urease activity on pathogenic differences among Brucella species was evaluated. In cell-free extracts, the B. suis urease showed 12 times greater specific activity than the B. melitensis urease. When Fis...Importance of urease activity on pathogenic differences among Brucella species was evaluated. In cell-free extracts, the B. suis urease showed 12 times greater specific activity than the B. melitensis urease. When Fisher-344 rats were inoculated intraperitoneally (IP), at 1 week post-inoculation (PI), B. melitensis wild type 16 M was recovered from spleens and livers in greater numbers than B. suis wild type 1330. At 8 weeks PI, spleens were clear of B. melitensis, whereas B. suis remained. The wild type and the urease deficient strains of B. suis did not differ from each other in terms of recovery from spleen or liver. Our observations suggest that B. melitensis induces greater acute infectivity in Fisher-344 rats, whereas B. suis causes chronic infectivity;and urease activity has no influence on Brucella infection using an IP route.展开更多
Splenomegaly is a well-known phenomenon typically associated with inflammation.However,the underlying cause of this phenotype has not been well characterized.Furthermore,the splenomegaly phenotype seen in lymphotoxin(...Splenomegaly is a well-known phenomenon typically associated with inflammation.However,the underlying cause of this phenotype has not been well characterized.Furthermore,the splenomegaly phenotype seen in lymphotoxin(LT)signaling-deficient mice is characterized by increased numbers of splenocytes and splenic neutrophils.Splenomegaly,as well as the related phenotype of increased lymphocyte counts in non-lymphoid tissues,is thought to result from the absence of secondary lymphoid tissues in LT-deficient mice.We now present evidence that mice deficient in LTα1β2 or LTβR develop splenomegaly and increased numbers of lymphocytes in non-lymphoid tissues in a microbiota-dependent manner.Antibiotic administration to LTα1β2-or LTβR-deficient mice reduces splenomegaly.Furthermore,re-derived germ-free Ltbr−/−mice do not exhibit splenomegaly or increased inflammation in non-lymphoid tissues compared to specific pathogen-free Ltbr−/−mice.By using various LTβ-and LTβR-conditional knockout mice,we demonstrate that retinoic acid-related orphan receptorγT-positive type 3 innate lymphoid cells provide the required active LT signaling to prevent the development of splenomegaly.Thus,this study demonstrates the importance of LT-mediated immune responses for the prevention of splenomegaly and systemic inflammation induced by microbiota.展开更多
Background:Severe hepatosplenic complications arise in patients with chronic Schistosoma mansoni infection after heavy exposure to disease agents in endemic areas.These complications are rarely reported and,hence,unde...Background:Severe hepatosplenic complications arise in patients with chronic Schistosoma mansoni infection after heavy exposure to disease agents in endemic areas.These complications are rarely reported and,hence,underestimated.Case presentation:We report on eight patients with severe morbidity associated with S.mansoni infection in Ituri Province,northeastern Democratic Republic of Congo(DRC).The patients were identified during a community-based survey in 2017;one patient was seen at the district hospital.After taking the patients'history,a clinical examination and an abdominal ultrasonographical examination were performed.S.mansoni infection was diagnosed in fecal(Kato-Katz technique)and urine(point-of-case circulating cathodic antigen test)samples.These eight patients with severe intestinal and hepatosplenic complications were identified from four villages with high 5.mansoni infection prevalence and related morbidity.The patients'ages ranged from 19 to 57 years;four patients were women.Three patients reported hematemesis.Two patients were severely anemic.All patients reported non-specific abdominal symptoms,such as diarrhea(six patients),abdominal pain(seven patients),and blood in the stool(five patients),as well as weight loss(two patients).Abdominal ultrasonography revealed ascites in four patients.All patients had portal hypertension with hepatomegaly(seven patients)or splenomegaly(five patients).Of the six patients with a discernable liver parenchyma pattern,five displayed pattern F and three patient displayed pattern E.Liver parenchyma was not visible for two patients with severe ascites.An 5.mansoni infection was confirmed in six patients,with infection intensity ranging from light to heavy.All S.mansoni positive patients were treated with praziquantel(40 mg/kg body weight)and referred to the district hospital for follow-up.One patient with severe ascites died two weeks after we saw her.Due to security and accessibility reasons,the villages could not be visited again and the patients were lost to follow-up.Conclusions:Our observations of patients with severe schistosomiasis document the severe degree of endemicity of S.mansoni in the province and suggest an urgent need for adequate schistosomiasis control measures that target vulnerable population groups and address severe complications.展开更多
Background:Type 1 autoimmune pancreatitis(AIP)is the pancreatic manifestation of IgG4-related disease.However,this benign disease can result in the peripancreatic vascular involvement(PVI)on occasion,which increases t...Background:Type 1 autoimmune pancreatitis(AIP)is the pancreatic manifestation of IgG4-related disease.However,this benign disease can result in the peripancreatic vascular involvement(PVI)on occasion,which increases the difficulty of diagnosis and treatment of this clinical entity as well as for differentiating it from pancreatic malignancies.Methods:We retrospectively reviewed the information on demographics,clinical presentation,laboratory,imaging and endoscopic findings of 101 hospitalized patients with type 1 AIP treated in our department.All the patients were divided into non-PVI and PVI groups according to the first hospitalized medical data.Univariate and multivariate analyses were performed to analyse the potential predictive parameter(s)of PVI in AIP patients.Results:Among the 101 type 1 AIP patients,52(51.5%)exhibited PVI,with a male/female ratio 5.5:1.Their average age was 58.37±8.68 years old.Univariate analysis revealed that the location of pancreatitis lesions,including the pancreatic tail(P=0.010),the presence of splenomegaly(P=0.001)and the white blood cell(WBC)number in peripheral blood(P=0.020),were significantly associated with PVI.The location of pancreatitis lesions,including the pancreatic tail(P=0.023),and the presence of splenomegaly(P=0.010)were found to be independent predictors of the development of PVI by a multivariable regression analysis.A total of 18 out of 25 patients in PVI group who underwent corticosteroid treatment and no less than 6 months radiological follow-up showed improvement in vascular lesions,and no case exhibited exacerbation of PVI lesions during follow-up.Of 36 patients in non-PVI group who were followed up for no less than 6 months,only one case exhibited PVI.Conclusions:This retrospective study demonstrated that type 1 AIP was associated with a high proportion of PVI.Pancreatic tail involvement and splenomegaly may predict the PVI in type 1 AIP.PVI lesions are reversible in a subset of patients.展开更多
We present a rare case of spontaneous trans-splenic shunt and intra-splenic collaterals in a patient with liver cirrhosis and portal hypertension.The shunt and presence of cirrhosis and portal hypertension was inciden...We present a rare case of spontaneous trans-splenic shunt and intra-splenic collaterals in a patient with liver cirrhosis and portal hypertension.The shunt and presence of cirrhosis and portal hypertension was incidentally detected by abdominal computed tomographic imaging during evaluation for abdominal pain.There has been a single report on the presence of trans-splenic shunt in two children with extra-hepatic portal venous obstruction but no cases that report intra-splenic collaterals:to the best of our knowledge,this is the first reported case of spontaneous trans-splenic shunt in the presence of intra-splenic collaterals and incidental multiple splenic artery aneurysms that developed in an adult with compensated cirrhosis and portal hypertension.展开更多
文摘Although the clinical benefit of laparoscopic splenectomy and devascularization(LSD) has been elaborated in many studies,its application in massive splenomegaly remains controversial.We conducted a retrospective research to assess the curative efficacy of LSD for massive splenomegaly due to portal hypertension.Forty-seven patients with massive splenomegaly due to portal hypertension were enrolled in this study,and divided into two groups.Twenty-one patients underwent open splenectomy and devascularization(OSD) from June 2010 to October 2012(OSD group).From March 2013 to February 2015,LSD was performed on 26 patients(LSD group).Perioperative variables were analyzed.Compared to OSD,LSD was associated with less blood loss(241.9±110.0 m L vs.319.0±139.5 m L,P<0.05),more rapid resumption of oral diet(2.46±0.95 days vs.3.76±1.09 days,P<0.05),and shorter postoperative hospital stay(5.35±1.65 days vs.7.24±1.55 days,P<0.05).It was concluded that for patients with massive splenomegaly due to portal hypertension,LSD is feasible and as safe as OSD.
基金National Natural Science Foundation of China,No.81870444Tianjin Natural Science Foundation,No.19JCQNJC10300Spring Bud Plan of Tianjin First Central Hospital,No.TFCHCL201801.
文摘BACKGROUND The most effective treatment for advanced cirrhosis and portal hypertension is liver transplantation(LT).However,splenomegaly and hypersplenism can persist even after LT in patients with massive splenomegaly.AIM To examine the feasibility of performing partial splenectomy during LT in patients with advanced cirrhosis combined with severe splenomegaly and hypersplenism.METHODS Between October 2015 and February 2019,762 orthotopic LTs were performed for patients with end-stage liver diseases in Tianjin First Center Hospital.Eighty-four cases had advanced cirrhosis combined with severe splenomegaly and hypersplenism.Among these patients,41 received partial splenectomy during LT(PSLT group),and 43 received only LT(LT group).Patient characteristics,intraoperative parameters,and postoperative outcomes were retrospectively analyzed and compared between the two groups.RESULTS The incidence of postoperative hypersplenism(2/41,4.8%)and recurrent ascites(1/41,2.4%)in the PSLT group was significantly lower than that in the LT group(22/43,51.2%;8/43,18.6%,respectively).Seventeen patients(17/43,39.5%)in the LT group required two-stage splenic embolization,and further splenectomy was required in 6 of them.The operation time and intraoperative blood loss in the PSLT group(8.6±1.3 h;640.8±347.3 mL)were relatively increased compared with the LT group(6.8±0.9 h;349.4±116.1 mL).The incidence of postoperative bleeding,pulmonary infection,thrombosis and splenic arterial steal syndrome in the PSLT group was not different to that in the LT group,respectively.CONCLUSION Simultaneous PSLT is an effective treatment and should be performed in patients with advanced cirrhosis combined with severe splenomegaly and hypersplenism to prevent postoperative persistent hypersplenism.
基金Supported by the National Natural Science Foundation of China,No.81760514Youth Science Fund of Jiangxi Provincial Science and Technology Department,No.20161BAB215252
文摘BACKGROUND Hand-assisted laparoscopic splenectomy(HALS) can help overcome the drawbacks of laparoscopic splenectomy(LS) while maintaining its advantages.AIM To evaluate the efficacy and advantages of HALS for splenomegaly.METHODS The relevant literature was reviewed using the PubMed, EMBASE, Cochrane,Ovid Medline, and Wanfang databases to compare the clinical outcomes of HALS and LS. Odds ratios or mean differences were calculated with 95% confidence intervals for fixed-effects and random-effects models. Overall, 754 patients from16 trials who met the inclusion criteria were selected.RESULTS In pure splenectomy, blood loss volume(P < 0.001) and conversion rate(P =0.008) were significantly lower in the HALS group than in the LS group.Conversely, for splenomegaly, the operative time(P = 0.04) was shorter and blood loss volume(P < 0.001) and conversion rate(P = 0.001) were significantly lower in the HALS group than in the LS group. However, no significant difference was observed in hospital stay length, blood transfusion, time to food intake, complications, or mortality rate between the two groups. Moreover, in splenectomy and devascularization of the upper stomach(DUS), the operative time(P = 0.04) was significantly shorter and blood loss volume(P < 0.001) andconversion rate(P = 0.05) were significantly lower in the HALS + DUS group than in the LS + DUS group. However, no significant difference was observed in hospital stay length, timing of diet, and complications between the two groups.CONCLUSION HALS is an ideal surgical treatment method for splenomegaly because it can maximize the benefits for patients while maintaining the advantages of LS.
基金supported by by the University of Malaya research grant(BKP 007-2014)
文摘We report a case of a patient with Schistosoma mansoni infection who presented with liver cirrhosis and splenomegaly.She was diagnosed by a serological test and Kato-Katz thick smear stool examination.The patient was a 52-year-old woman from Sudan who came to Malaysia for a week to visit her sons.The patient lives in the middle of Rabak region,Sudan,a highly endemic area for schistosomiasis where her daily routine includes rearing of cows and farming.The site of toilet and sources of drinking water are canals and wells;both infested with snails.Patient had a long history of exposure and coming into contact with water from these canals and wells.
文摘A 33-year-old primigravida presented to an appointment at a high-risk prenatal outpatient service due to a history of splenomegaly. Her spleen occupied of the abdominal cavity and shifted the uterus to the right side of the abdomen. During investigation, an intrauterine growth restriction (IURG) and a series of other clinical complications were discovered. We admitted her to inpatient care at 28 + 1 weeks’ gestation for a better investigation of her extensive splenomegaly and for pregnancy monitoring, with a further successful delivery.
文摘Splenomegaly, sometimes of massive extent, occurs in a large number of hereditary diseases, some relatively prevalent and others, rare to ultra-rare. Because physicians are often unfamiliar with the less common disorders, patients may suffer because of diagnostic delay or diagnostic error and may undergo invasive, non-innocuous procedures such as splenectomy that are potentially avoidable were the correct diagnosis suspected. In this review article, we discuss the definition and clinical ramifications of “massive” splenomegaly and describe several rare genetic disorders that are sometimes associated with marked splenic enlargement as well as four additional hereditary “splenomegalic” lysosomal storage diseases (cholesterol esterase storage disease, Niemann-Pick C disease, acid sphingomyelinase deficiency disease, Gaucher disease) in which approved or promising experimental treatments should generally obviate the need for palliative splenectomy. We also summarize current concepts about the appropriate use of splenectomy in patients with β-thalassemia, hereditary spherocytosis and Gaucher disease and discuss surgical alternatives to classical total splenectomy for these disorders.
文摘Introduction: Sickle cell disease is the most common hemoglobinopathy in the world. Sickle cells are quickly fixed and destroyed by the elements of the reticuloendothelial system mainly in the spleen. It leads to a palpable increase in the volume of the spleen called splenomegaly. Splenomegaly is the cause of multiple complications that are relatively frequent and potentially serious in sickle cell disease, such as splenic sequestration seizures, spleen rupture, hypersplenism and splenic abscesses. We aimed at determining the prevalence of splenomegaly and to study the associated factors in patients with sickle cell disease. Materials and Methods: This was an analytical cross-sectional study, conducted from 1 January to 30 April 2019, at the Mother and Child Center of the Chantal BIYA Foundation. Patients were grouped into two groups: patients with splenomegaly (PS1) and patients without splenomegaly (PS0). As soon as we obtained the informed consent of the parents, we examined the children and recorded socio-demographic data, disease history and follow-up, documented complications, and clinical findings;then we performed the Rapid Malaria Diagnostic Test. The statistical analyzes were carried out using SPSS20 (Statistical Package for Social Sciences) and Microsoft Excel 2010 software. Results: We examined 403 children with sickle cell disease and 142 had splenomegaly (35%). Almost all of the study populations were homozygous SS. The Hackett 2 stage of splenomegaly was the most frequent (56.7%). The most common physical sign among PS1 was the presence of abdominal scarring (50.7% vs. 19.4%). PS1 had significantly lower levels of Hb (6.94 ± 1.67 vs 7.62 ± 1.43 p = 0.003) and platelets (297.45 ± 146.25 vs 398.70 ± 163.73 p < 0.001) than patients without splenomegaly (PS0). However, the percentages of HbF (21.78 ± 10.48 vs 15.66 ± 9.20 p < 0.001) and malaria infection (74.6% vs 17.2% p < 0.001) were statistically higher among PS0. Logistic regression analysis determined that the factors associated with splenomegaly were: malaria, high fetal hemoglobin, low hemoglobin S, hepatomegaly, thrombocytopenia and use of non-steroidal anti-inflammatory drugs. Conclusion: Splenomegaly is a frequent physical sign of sickle cell disease in children and factors associated are malaria, high hemoglobin F, low hemoglobin S, hepatomegaly, thrombocytopenia and NSAID use.
文摘<strong>Background:</strong> Inhabitants from malaria endemic zones often present with enlarged spleen, mainly due to hyper reactive malarial splenomegaly (HMS), and it is seen more commonly associated with elevated levels of Immunoglobulin M (IgM). Cold agglutinin disease is an acquired autoimmune hemolytic anemia (AIHA) that is usually due to cold-reacting IgM autoantibodies directed against red cell antigens. The study was conducted in response to the observed high frequency of transfusion dependent anemia in patients with splenomegaly from malaria endemic zones in southern province of Rwanda. The objectives of this study were to determine the prevalence of cold agglutinin disease and to assess the distribution of IgM antibodies among these patients. <strong>Methodology:</strong> This was a descriptive, cross-sectional study conducted over a period of six months from June 2016 to December 2016. The study enrolled adult population from malaria endemic areas of the southern province of Rwanda with unexplained splenomegaly. Blood samples for testing IgM levels, cold agglutinin, FBC, and markers of hemolysis were collected from peripheral health settings and analyzed at the laboratory of Butare University Teaching Hospital. <strong>Results:</strong> During the study period, we enrolled 188 participants with enlarged spleen. One hundred twenty-five (66%) were females and 34% were males. The mean (±SD) age of the study participants was 35.6 ± 15.2 years. Out of 188 participants, only 4.8% were found with significantly positive Cold Agglutinin Titer (CAT) (≥1:64) and 84% of participants were found to have elevated serum IgM level. Hemoglobin level, white blood count and platelets count decrease with severity of splenomegaly, while IgM level increases with spleen size. <strong>Conclusion:</strong> Among patients with splenomegaly from malaria endemic areas, IgM levels correlate with the stages of splenomegaly while cold agglutinin disease plays a small role in the etiology of anemia.
基金Supported by a grant from graduate school(GSEU 20RR0234/2011),Egerton University Faculty Research Committee.
文摘Objective:To establish the modulatory effects of coenzyme Q_(10)on experimental trypanosome infections in mice and evaluate the risk of occurrence and severity of melarsoprol-induced post treatment reactive encephalopathy(PTRE).Methods:Female Swiss white mice were orally administered with 200 mg/kg of coenzyme Q_(10)after which they were intraperitoneally inoculated with Trypanasoma brucei rhodesiense(T.b.rhodesiense).The resultant infection was allowed to develop and simulate all phases of human African trypanosomiasis and PTRE.Parasitaemia development,packed cell volume,haematological and pathological changes were determined.Results:A histological study in the brain tissue of T.b.rhodesiense infected mice demonstrated neuroinflammatory pathology which was highly amplified in the PTRE-induced groups.A prominent reduction in the severity of the neuroinflammatory response was detected when coenzyme-Q_(10)was administered.Furthermore,the mean tissue weight of spleen to body ratio in coenzyme Q_(10)supplemented group was significantly(P<0.05)different compared to un-supplemented groups,and clearly indicated that coenzyme Q_(10)prevented full blown splenomegaly pathogenesis by T.b.rhodesiense.A significant(P<0.05)increase in hemoglobin levels and red blood cells was observed in coenzyme Q_(10)mice compared to those infected and un-supplemented with coenzyme Q_(10).Conclusions:The capacity of coenzyme Q_(10)to alter the pathogenesis of T.b.rhodesiense infection in mice and following treatment with melarsoprol,may find application by rendering humans and animals less susceptible to deleterious effects of trypanosome infection such as splenomegaly and melarsoprol-induced PTRE and neurotoxicity.
文摘Niemann-Pick disease (NPD) refers to a group of patients who have varying degrees of lipid storage and foam cell infiltration in tissues, as well as overlapping clinical features, including hepatosplenomegaly, insufficiency pulmonary and/or central nervous system (CNS). Thanks to the pioneering work of Roscoe Brady and colleagues, we now know that there are two distinct metabolic abnormalities that explain NPD. The first is due to the deficient activity of the acid sphingomyelinase enzyme (ASM;NPD “types A and B”), and the second is due to defective functioning in the transport of cholesterol (NPD “type C”). We report the case of a 13-year-old adolescent diagnosed with Niemann-Pick A/B disease.
文摘Since early 1990's,when it was inaugurally introduced,laparoscopic splenectomy has been performed with excellent results in terms of intraoperative and postoperative complications.Nowadays laparoscopic splenectomy is the approach of choice for both benign and malignant diseases of the spleen.However some contraindications still apply.The evolution of the technology has allowed though,cases which were considered to be absolute contraindications for performing a minimal invasive procedure to be treated with modified laparoscopic approaches.Moreover,the introduction of advanced laparoscopic tools for ligation resulted in less intraoperative complications.Today,laparoscopic splenectomy is considered safe,with better outcomes in comparison to open splenectomy,and the increased experience of surgeons allows operative times comparable to those of an open splenectomy.In this review we discuss the indications and the contraindications of laparoscopic splenectomy.Moreover we analyze the standard and modified surgical approaches,and we evaluate the short-term and long-term outcomes.
文摘A littoral cell angioma(LCA) is a primary vascular tumor of the spleen, that can have malignant potential and may present association with other malignancies. This is a case of LCA that was discovered incidentally in a 79-year-old woman who presented with a polycythemia at the time of consultation. The neoplasm was evaluated by ultrasound and computed tomography. The patient underwent a splenectomy that revealed LCA by pathological evaluation. The post-operative outcome was favorable with no complications or recurrent disease. This case presentation, clinical, radiographic, and pathological features of an uncommon splenic tumor can be studied in order to advance our knowledge in our understanding of LCA.
文摘Primary histiocytic sarcoma of the spleen is a rare but potentially lethal condition. It can remain asymptomatic or only mildly symptomatic for a long time. An 81-year-old woman presented with an extremely enlarged spleen. She suffered from progressive anemia and required a red blood cell transfusion once a month. Although computed tomography, ultrasonography, and magnetic resonance imaging were performed for diagnosis, a confirmed diagnosis was not obtained. Her enlarged spleen compressed her stomach, and she suffered from gastritis and a sense of gastric fullness just after meals. She underwent laparoscopic splenectomy for therapeutic and diagnostic purposes. Her postoperative course was uneventful. After surgery, her red blood cell and platelet counts increased markedly. The tumor was diagnosed as splenic histiocytic sarcoma. Post-surgical chemotherapy was not performed, and the patient died of liver failure due to liver metastasis 5 mo after surgery. Laparoscopic splenectomy is minimally invasive and useful for the relief of symptoms related to hematological disorders. However, in cases of an enlarged spleen, optimal views and working space are limited. In such cases, splenic artery ligation can markedly reduce the size of the spleen, thus facilitating the procedure. The case reported herein suggests that laparoscopic splenectomy may be useful for the treatment of splenic malignancy.
基金Supported by the Medical and Health Technology Plan of Zhejiang Province,No.2020KY1086 and No.2022ZH086。
文摘BACKGROUND Primary liver cancer is one of the most common malignant tumours,while primary splenic lymphoma is a rare malignancy.Thus,cases of hepatocellular carcinoma(HCC)combined with splenic lymphoma are extremely rare.CASE SUMMARY We present a 62-year-old woman who was admitted to the Interventional Radiology Department with a lump in the spleen and liver as well as multiple enlarged lymph nodes visible by ultrasound.Contrast-enhanced computed of the abdomen revealed a circular,low-density,shallow mass(approximately 2.6 cm in diameter)in the left intrahepatic lobe and multiple round,low-density shadows in the spleen with clear boundaries(maximum diameter 7.6 cm).Based on the characteristic clinical symptoms and explicit radiological findings,the clinical diagnosis was HCC with metastasis to the liver portal,retroperitoneal lymph nodes,and spleen.After transcatheter arterial chemoembolization and sequential radiofrequency ablation,the-fetoprotein level returned to the normal range,and the hepatitis B cirrhosis improved.In addition,splenic tumour biopsy confirmed the diagnosis of primary malignant lymphoma,which went into remission after chemotherapy.CONCLUSION HCC with primary splenic non-Hodgkin lymphoma is extremely rare and easily misdiagnosed.Better understanding would facilitate early diagnosis,treatment and prognosis.
文摘A 57-year-old female was admitted with pancytopenia, and mild splenomegaly. The multiple myeloma diagnosis was wrongly made since the discovery of monoclonal peak to the protein electrophoresis. Further microscopic examination of bone marrow revealed the accumulation of sea-blue histiocytes. The evolution was stable and the patient did not receive any treatment due to the lack of nervous symptoms.
文摘Importance of urease activity on pathogenic differences among Brucella species was evaluated. In cell-free extracts, the B. suis urease showed 12 times greater specific activity than the B. melitensis urease. When Fisher-344 rats were inoculated intraperitoneally (IP), at 1 week post-inoculation (PI), B. melitensis wild type 16 M was recovered from spleens and livers in greater numbers than B. suis wild type 1330. At 8 weeks PI, spleens were clear of B. melitensis, whereas B. suis remained. The wild type and the urease deficient strains of B. suis did not differ from each other in terms of recovery from spleen or liver. Our observations suggest that B. melitensis induces greater acute infectivity in Fisher-344 rats, whereas B. suis causes chronic infectivity;and urease activity has no influence on Brucella infection using an IP route.
文摘Splenomegaly is a well-known phenomenon typically associated with inflammation.However,the underlying cause of this phenotype has not been well characterized.Furthermore,the splenomegaly phenotype seen in lymphotoxin(LT)signaling-deficient mice is characterized by increased numbers of splenocytes and splenic neutrophils.Splenomegaly,as well as the related phenotype of increased lymphocyte counts in non-lymphoid tissues,is thought to result from the absence of secondary lymphoid tissues in LT-deficient mice.We now present evidence that mice deficient in LTα1β2 or LTβR develop splenomegaly and increased numbers of lymphocytes in non-lymphoid tissues in a microbiota-dependent manner.Antibiotic administration to LTα1β2-or LTβR-deficient mice reduces splenomegaly.Furthermore,re-derived germ-free Ltbr−/−mice do not exhibit splenomegaly or increased inflammation in non-lymphoid tissues compared to specific pathogen-free Ltbr−/−mice.By using various LTβ-and LTβR-conditional knockout mice,we demonstrate that retinoic acid-related orphan receptorγT-positive type 3 innate lymphoid cells provide the required active LT signaling to prevent the development of splenomegaly.Thus,this study demonstrates the importance of LT-mediated immune responses for the prevention of splenomegaly and systemic inflammation induced by microbiota.
基金The study was funded by private funds(Poverty Foundation,Basel,Switzerland).
文摘Background:Severe hepatosplenic complications arise in patients with chronic Schistosoma mansoni infection after heavy exposure to disease agents in endemic areas.These complications are rarely reported and,hence,underestimated.Case presentation:We report on eight patients with severe morbidity associated with S.mansoni infection in Ituri Province,northeastern Democratic Republic of Congo(DRC).The patients were identified during a community-based survey in 2017;one patient was seen at the district hospital.After taking the patients'history,a clinical examination and an abdominal ultrasonographical examination were performed.S.mansoni infection was diagnosed in fecal(Kato-Katz technique)and urine(point-of-case circulating cathodic antigen test)samples.These eight patients with severe intestinal and hepatosplenic complications were identified from four villages with high 5.mansoni infection prevalence and related morbidity.The patients'ages ranged from 19 to 57 years;four patients were women.Three patients reported hematemesis.Two patients were severely anemic.All patients reported non-specific abdominal symptoms,such as diarrhea(six patients),abdominal pain(seven patients),and blood in the stool(five patients),as well as weight loss(two patients).Abdominal ultrasonography revealed ascites in four patients.All patients had portal hypertension with hepatomegaly(seven patients)or splenomegaly(five patients).Of the six patients with a discernable liver parenchyma pattern,five displayed pattern F and three patient displayed pattern E.Liver parenchyma was not visible for two patients with severe ascites.An 5.mansoni infection was confirmed in six patients,with infection intensity ranging from light to heavy.All S.mansoni positive patients were treated with praziquantel(40 mg/kg body weight)and referred to the district hospital for follow-up.One patient with severe ascites died two weeks after we saw her.Due to security and accessibility reasons,the villages could not be visited again and the patients were lost to follow-up.Conclusions:Our observations of patients with severe schistosomiasis document the severe degree of endemicity of S.mansoni in the province and suggest an urgent need for adequate schistosomiasis control measures that target vulnerable population groups and address severe complications.
基金National Natural Science Foundation of China,Joint Fund Project(grant No.U20A600)National Key R&D Program of China(grant No.2020YFC2002702)+1 种基金National Key Technology Research and Development Program(grant No.2016YFC1302802)Beijing Municipal Science and Technology Project(grant No.Z181100001618013).
文摘Background:Type 1 autoimmune pancreatitis(AIP)is the pancreatic manifestation of IgG4-related disease.However,this benign disease can result in the peripancreatic vascular involvement(PVI)on occasion,which increases the difficulty of diagnosis and treatment of this clinical entity as well as for differentiating it from pancreatic malignancies.Methods:We retrospectively reviewed the information on demographics,clinical presentation,laboratory,imaging and endoscopic findings of 101 hospitalized patients with type 1 AIP treated in our department.All the patients were divided into non-PVI and PVI groups according to the first hospitalized medical data.Univariate and multivariate analyses were performed to analyse the potential predictive parameter(s)of PVI in AIP patients.Results:Among the 101 type 1 AIP patients,52(51.5%)exhibited PVI,with a male/female ratio 5.5:1.Their average age was 58.37±8.68 years old.Univariate analysis revealed that the location of pancreatitis lesions,including the pancreatic tail(P=0.010),the presence of splenomegaly(P=0.001)and the white blood cell(WBC)number in peripheral blood(P=0.020),were significantly associated with PVI.The location of pancreatitis lesions,including the pancreatic tail(P=0.023),and the presence of splenomegaly(P=0.010)were found to be independent predictors of the development of PVI by a multivariable regression analysis.A total of 18 out of 25 patients in PVI group who underwent corticosteroid treatment and no less than 6 months radiological follow-up showed improvement in vascular lesions,and no case exhibited exacerbation of PVI lesions during follow-up.Of 36 patients in non-PVI group who were followed up for no less than 6 months,only one case exhibited PVI.Conclusions:This retrospective study demonstrated that type 1 AIP was associated with a high proportion of PVI.Pancreatic tail involvement and splenomegaly may predict the PVI in type 1 AIP.PVI lesions are reversible in a subset of patients.
文摘We present a rare case of spontaneous trans-splenic shunt and intra-splenic collaterals in a patient with liver cirrhosis and portal hypertension.The shunt and presence of cirrhosis and portal hypertension was incidentally detected by abdominal computed tomographic imaging during evaluation for abdominal pain.There has been a single report on the presence of trans-splenic shunt in two children with extra-hepatic portal venous obstruction but no cases that report intra-splenic collaterals:to the best of our knowledge,this is the first reported case of spontaneous trans-splenic shunt in the presence of intra-splenic collaterals and incidental multiple splenic artery aneurysms that developed in an adult with compensated cirrhosis and portal hypertension.
