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. 2021 Apr 6;10(7):1519.
doi: 10.3390/jcm10071519.

Diagnostic Splenectomy: Characteristics, Pre-Operative Investigations, and Identified Pathologies for 20 Patients

Jean Maillot  1   2 , Jean-Valère Malfuson  2 , Thierry Lazure  3 , Stéphane Benoist  4 , Anne Cremades  5 , Emmanuel Hornez  6 , Florent L Besson  7   8 , Nicolas Noël  1   8   9 , Olivier Lambotte  1   8   9
Affiliations

Diagnostic Splenectomy: Characteristics, Pre-Operative Investigations, and Identified Pathologies for 20 Patients

Jean Maillot et al. J Clin Med. .

Abstract

Splenectomy is indicated in cases of trauma to the spleen or hematological and immunological diseases (hereditary spherocytosis, autoimmune cytopenia). Less frequently, splenectomy is performed for diagnostic purposes to complement unsuccessful prior etiological investigations. The splenectomy remains a surgery at risk of complications and should be considered as a last-resort procedure to make the diagnosis and to be able to treat patients. We studied the medical files of 142 patients who underwent a splenectomy for any reason over a 10-year period and identified 20 diagnostic splenectomies. Diagnostic splenectomies were mainly performed to explore unexplained splenomegaly for 13 patients and fever of unknown origin for 10. The other patients had surgery for other causes (cytopenia, abdominal symptoms, suspicion of relapsing malignant hemopathies). Splenectomy contributed to the final diagnosis in 19 of 20 cases, corresponding mostly to lymphoid hemopathies (14/20). The most frequent disease was diffuse large B-cell lymphoma (8/20). Splenectomy did not reveal any infectious disease. The most relevant pre-operative procedures to aid the diagnosis were 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) and immuno-hematological examinations. Diagnostic splenectomy is useful and necessary in certain difficult diagnostic situations. Highlights: Diagnostic splenectomy is still useful in 2020 to diagnose unexplained splenomegaly or fever of unknown origin. Lymphoma was the most common final diagnosis. FDG PET/CT was the most useful tool to aid in the diagnosis.

Keywords: FDG PET/CT; bone-marrow biopsy; diagnostic investigations; diagnostic splenectomy; lymphoproliferative disease; malignant hematologic disorders.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Flow chart. ITP, immune thrombocytopenic purpura.
Figure 2
Figure 2
Identified pathologies (represented as the absolute number of patients).
Figure 3
Figure 3
Diagnostic splenectomy: an algorithm to help clinical decision-making according to first-line examinations.
See this image and copyright information in PMC

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