Abstract
We report three cystic fibrosis (CF) patients with hypersplenism who underwent partial splenectomy. The postoperative course was uneventful in two patients; one patient developed a complication necessitating resection of the rest of the spleen. Haematological parameters improved and oesophageal varices regressed in all patients. On follow up, one patient showed a normal spleen, the other a normally functioning accessory spleen; the third patient again developed splenomegaly with hypersplenism. Partial splenectomy is a promising therapeutic option for CF patients with hypersplenism.
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- Bar-Maor J. A., Govrin-Yehudain J. Partial splenectomy in children with Gaucher's disease. Pediatrics. 1985 Sep;76(3):398–401. [PubMed] [Google Scholar]
- Berger H., Bugnon F., Goffette P., Steiner W., Strobelt M., Flemmer A., de Ville de Goyet J., Clapuyt P., Otte J. B., Buts J. P. Percutaneous transjugular intrahepatic stent shunt for treatment of intractable varicose bleeding in paediatric patients. Eur J Pediatr. 1994 Oct;153(10):721–725. doi: 10.1007/BF01954487. [DOI] [PubMed] [Google Scholar]
- Cooney D. R., Dearth J. C., Swanson S. E., Dewanjee M. K., Telander R. L. Relative merits of partial splenectomy, splenic reimplantation, and immunization in preventing postsplenectomy infection. Surgery. 1979 Oct;86(4):561–569. [PubMed] [Google Scholar]
- Couetil J. P., Soubrane O., Houssin D. P., Dousset B. E., Chevalier P. G., Guinvarch A., Loulmet D., Achkar A., Carpentier A. F. Combined heart-lung-liver, double lung-liver, and isolated liver transplantation for cystic fibrosis in children. Transpl Int. 1997;10(1):33–39. doi: 10.1007/BF02044339. [DOI] [PubMed] [Google Scholar]
- Davis P. B., Drumm M., Konstan M. W. Cystic fibrosis. Am J Respir Crit Care Med. 1996 Nov;154(5):1229–1256. doi: 10.1164/ajrccm.154.5.8912731. [DOI] [PubMed] [Google Scholar]
- Debray D., Lykavieris P., Gauthier F., Dousset B., Sardet A., Munck A., Laselve H., Bernard O. Outcome of cystic fibrosis-associated liver cirrhosis: management of portal hypertension. J Hepatol. 1999 Jul;31(1):77–83. doi: 10.1016/s0168-8278(99)80166-4. [DOI] [PubMed] [Google Scholar]
- Debray D., Lykavieris P., Gauthier F., Dousset B., Sardet A., Munck A., Laselve H., Bernard O. Outcome of cystic fibrosis-associated liver cirrhosis: management of portal hypertension. J Hepatol. 1999 Jul;31(1):77–83. doi: 10.1016/s0168-8278(99)80166-4. [DOI] [PubMed] [Google Scholar]
- Diamond L. K. Splenectomy in childhood and the hazard of overwhelming infection. Pediatrics. 1969 May;43(5):886–889. [PubMed] [Google Scholar]
- Donovan T. J., Ward M., Shepherd R. W. Evaluation of endoscopic sclerotherapy of esophageal varices in children. J Pediatr Gastroenterol Nutr. 1986 Sep-Oct;5(5):696–700. doi: 10.1097/00005176-198609000-00005. [DOI] [PubMed] [Google Scholar]
- Feigelson J., Anagnostopoulos C., Poquet M., Pecau Y., Munck A., Navarro J. Liver cirrhosis in cystic fibrosis--therapeutic implications and long term follow up. Arch Dis Child. 1993 May;68(5):653–657. doi: 10.1136/adc.68.5.653. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Feigelson J., Anagnostopoulos C., Poquet M., Pecau Y., Munck A., Navarro J. Liver cirrhosis in cystic fibrosis--therapeutic implications and long term follow up. Arch Dis Child. 1993 May;68(5):653–657. doi: 10.1136/adc.68.5.653. [DOI] [PMC free article] [PubMed] [Google Scholar]
- FitzSimmons S. C. The changing epidemiology of cystic fibrosis. J Pediatr. 1993 Jan;122(1):1–9. doi: 10.1016/s0022-3476(05)83478-x. [DOI] [PubMed] [Google Scholar]
- Genyk Y. S., Quiros J. A., Jabbour N., Selby R. R., Thomas D. W. Liver transplantation in cystic fibrosis. Curr Opin Pulm Med. 2001 Nov;7(6):441–447. doi: 10.1097/00063198-200111000-00014. [DOI] [PubMed] [Google Scholar]
- Goldstone J. Splenectomy for massive splenomegaly. Am J Surg. 1978 Mar;135(3):385–388. doi: 10.1016/0002-9610(78)90071-5. [DOI] [PubMed] [Google Scholar]
- Gürleyik E., Gürleyik G., Bingöl K., Akkaya L., Unalmişer S. Perfusion and functional anatomy of the splenic remnant supplied by short gastric vessels. Am J Surg. 2000 Jun;179(6):490–493. doi: 10.1016/s0002-9610(00)00387-1. [DOI] [PubMed] [Google Scholar]
- Havlik R. J., Touloukian R. J., Markowitz R. I., Buckley P. Partial splenectomy for symptomatic splenic hamartoma. J Pediatr Surg. 1990 Dec;25(12):1273–1275. doi: 10.1016/0022-3468(90)90529-i. [DOI] [PubMed] [Google Scholar]
- Heaton N. D., Howard E. R. Complications and limitations of injection sclerotherapy in portal hypertension. Gut. 1993 Jan;34(1):7–10. doi: 10.1136/gut.34.1.7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Heyman M. B., LaBerge J. M. Role of transjugular intrahepatic portosystemic shunt in the treatment of portal hypertension in pediatric patients. J Pediatr Gastroenterol Nutr. 1999 Sep;29(3):240–249. doi: 10.1097/00005176-199909000-00004. [DOI] [PubMed] [Google Scholar]
- Idowu O., Hayes-Jordan A. Partial splenectomy in children under 4 years of age with hemoglobinopathy. J Pediatr Surg. 1998 Aug;33(8):1251–1253. doi: 10.1016/s0022-3468(98)90161-0. [DOI] [PubMed] [Google Scholar]
- Jahn S., Bauer B., Schwab J., Kirchmair F., Neuhaus K., Kiessig S. T., Volk H. D., Mau H., von Baehr R., Specht U. Immune restoration in children after partial splenectomy. Immunobiology. 1993 Aug;188(4-5):370–378. doi: 10.1016/S0171-2985(11)80220-2. [DOI] [PubMed] [Google Scholar]
- Kimber C., Spitz L., Drake D., Kiely E., Westaby S., Cozzi F., Pierro A. Elective partial splenectomy in childhood. J Pediatr Surg. 1998 Jun;33(6):826–829. doi: 10.1016/s0022-3468(98)90651-0. [DOI] [PubMed] [Google Scholar]
- Knechtle S. J., D'Alessandro A. M., Armbrust M. J., Musat A., Kalayoglu M. Surgical portosystemic shunts for treatment of portal hypertensive bleeding: outcome and effect on liver function. Surgery. 1999 Oct;126(4):708–713. [PubMed] [Google Scholar]
- Kumpe D. A., Rumack C. M., Pretorius D. H., Stoecker T. J., Stellin G. P. Partial splenic embolization in children with hypersplenism. Radiology. 1985 May;155(2):357–362. doi: 10.1148/radiology.155.2.3885306. [DOI] [PubMed] [Google Scholar]
- Louis D., Chazalette J. P. Cystic fibrosis and portal hypertension interest of partial splenectomy. Eur J Pediatr Surg. 1993 Feb;3(1):22–24. doi: 10.1055/s-2008-1063501. [DOI] [PubMed] [Google Scholar]
- MacDougall B. R., Westaby D., Theodossi A., Dawson J. L., Williams R. Increased long-term survival in variceal haemorrhage using injection sclerotherapy. Results of a controlled trial. Lancet. 1982 Jan 16;1(8264):124–127. doi: 10.1016/s0140-6736(82)90378-6. [DOI] [PubMed] [Google Scholar]
- Mack D. R., Traystman M. D., Colombo J. L., Sammut P. H., Kaufman S. S., Vanderhoof J. A., Antonson D. L., Markin R. S., Shaw B. W., Jr, Langnas A. N. Clinical denouement and mutation analysis of patients with cystic fibrosis undergoing liver transplantation for biliary cirrhosis. J Pediatr. 1995 Dec;127(6):881–887. doi: 10.1016/s0022-3476(95)70022-6. [DOI] [PubMed] [Google Scholar]
- Milkiewicz Piotr, Skiba Grzegorz, Kelly Deidre, Weller Peter, Bonser Robert, Gur Ufuk, Mirza Darius, Buckels John, Stableforth David, Elias Elwyn. Transplantation for cystic fibrosis: outcome following early liver transplantation. J Gastroenterol Hepatol. 2002 Feb;17(2):208–213. doi: 10.1046/j.1440-1746.2002.02671.x. [DOI] [PubMed] [Google Scholar]
- Molmenti E., Nagata D., Roden J., Squires R., Molmenti H., Casey D., Prestidge C., McPhail W., Sanchez E., Goldstein R. Pediatric liver transplantation for cystic fibrosis. Transplant Proc. 2001 Feb-Mar;33(1-2):1738–1738. doi: 10.1016/s0041-1345(00)02825-6. [DOI] [PubMed] [Google Scholar]
- Mutchnick M. G., Lerner E., Conn H. O. Portal-systemic encephalopathy and portacaval anastomosis: a prospective, controlled investigation. Gastroenterology. 1974 May;66(5):1005–1019. [PubMed] [Google Scholar]
- Noble-Jamieson G., Barnes N., Jamieson N., Friend P., Calne R. Liver transplantation for hepatic cirrhosis in cystic fibrosis. J R Soc Med. 1996;89 (Suppl 27):31–37. [PMC free article] [PubMed] [Google Scholar]
- Noble-Jamieson G., Valente J., Barnes N. D., Friend P. J., Jamieson N. V., Rasmussen A., Calne R. Y. Liver transplantation for hepatic cirrhosis in cystic fibrosis. Arch Dis Child. 1994 Oct;71(4):349–352. doi: 10.1136/adc.71.4.349. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Penketh A. R., Wise A., Mearns M. B., Hodson M. E., Batten J. C. Cystic fibrosis in adolescents and adults. Thorax. 1987 Jul;42(7):526–532. doi: 10.1136/thx.42.7.526. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Price M. R., Sartorelli K. H., Karrer F. M., Narkewicz M. R., Sokol R. J., Lilly J. R. Management of esophageal varices in children by endoscopic variceal ligation. J Pediatr Surg. 1996 Aug;31(8):1056–1059. doi: 10.1016/s0022-3468(96)90086-x. [DOI] [PubMed] [Google Scholar]
- Reinoso M. A., Sharp H. L., Rank J. Endoscopic variceal ligation in pediatric patients with portal hypertension secondary to liver cirrhosis. Gastrointest Endosc. 1997 Sep;46(3):244–246. doi: 10.1016/s0016-5107(97)70094-4. [DOI] [PubMed] [Google Scholar]
- Scott-Jupp R., Lama M., Tanner M. S. Prevalence of liver disease in cystic fibrosis. Arch Dis Child. 1991 Jun;66(6):698–701. doi: 10.1136/adc.66.6.698. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Scott-Jupp R., Lama M., Tanner M. S. Prevalence of liver disease in cystic fibrosis. Arch Dis Child. 1991 Jun;66(6):698–701. doi: 10.1136/adc.66.6.698. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shah R., Mahour G. H., Ford E. G., Stanley P. Partial splenic embolization. An effective alternative to splenectomy for hypersplenism. Am Surg. 1990 Dec;56(12):774–777. [PubMed] [Google Scholar]
- Shun A., Delaney D. P., Martin H. C., Henry G. M., Stephen M. Portosystemic shunting for paediatric portal hypertension. J Pediatr Surg. 1997 Mar;32(3):489–493. doi: 10.1016/s0022-3468(97)90613-8. [DOI] [PubMed] [Google Scholar]
- Sinaasappel M. Hepatobiliary pathology in patients with cystic fibrosis. Acta Paediatr Scand Suppl. 1989;363:45–51. doi: 10.1111/apa.1989.78.s363.45. [DOI] [PubMed] [Google Scholar]
- Sokol R. J., Durie P. R. Recommendations for management of liver and biliary tract disease in cystic fibrosis. Cystic Fibrosis Foundation Hepatobiliary Disease Consensus Group. J Pediatr Gastroenterol Nutr. 1999;28 (Suppl 1):S1–13. doi: 10.1097/00005176-199900001-00001. [DOI] [PubMed] [Google Scholar]
- Uranüs S., Kronberger L., Kraft-Kine J. Partial splenic resection using the TA-stapler. Am J Surg. 1994 Jul;168(1):49–53. doi: 10.1016/s0002-9610(05)80070-4. [DOI] [PubMed] [Google Scholar]
- Uranüs S., Mischinger H. J., Pfeifer J., Kronberger L., Jr, Rabl H., Werkgartner G., Steindorfer P., Kraft-Kirz J. Hemostatic methods for the management of spleen and liver injuries. World J Surg. 1996 Oct;20(8):1107–1112. doi: 10.1007/s002689900169. [DOI] [PubMed] [Google Scholar]
- Villaizán Pérez C., Román Pérez J., Bilbao Jaureguízar J. I., Sierrasesúmaga Ariznavarreta L., Villa-Elízaga I. Partial splenic embolisation and improvement of hypersplenism before liver transplantation. Arch Dis Child. 1995 Mar;72(3):243–244. doi: 10.1136/adc.72.3.243. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Zannini G., Masciariello S., Pagano G., Sangiuolo P., Zotti G., Iaccarino V. Percutaneous splenic artery occlusion for portal hypertension. A new mechanical technique for hypersplenism. Arch Surg. 1983 Aug;118(8):897–900. doi: 10.1001/archsurg.1983.01390080005001. [DOI] [PubMed] [Google Scholar]
