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Accessory spleens: Clinical significance with particular reference to the recurrence of idiopathic thrombocytopenic purpura

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Abstract

One of the important stages during splenectomy is the search for accessory spleens. The average frequency of accessory spleens is an estimated 11%. In our own material in 611 patients who had splenectomy in hematological disorders, accessory spleens were found in 110 patients (18%). The surgical anatomy, embryology, and clinical significance of the accessory spleens, with particular reference to the recurrence of idiopathic thrombocytopenic purpura (ITP) are discussed. The group of 177 patients with ITP treated by splenectomy 2–25 years ago is analyzed. Recurrence of thrombocytopenia after a good immediate response to splenectomy developed in 52 patients. In 13 patients the recurrence was transient, but in 19 it was longlasting. In these patients the presence of the accessory spleens was suspected by the absence of Howell-Jolly bodies in the peripheral blood. The accessory spleen was demonstrated by splenic scan in 16 cases and confirmed in 13 of the 15 patients who underwent reoperation. Removal of the accessory resulted in permanent disappearance of thrombocytopenia in 12 patients.

Résumé

Une des étapes importantes au cours des interventions pratiquées pour procéder à l'ablation de la rate est la recherche systématique de rates accessoires. Leur fréquence est de l'ordre de 11%. Chez 611 de nos malades qui ont subi une splénectomie pour affections hématologiques des rates accessoires ont été découvertes dans 110 cas (18%). L'anatomie chirurgicale, l'embryologie, la signification clinique des rates accessoires, en particulier en ce qui concerne le purpura thrombocytopénique idiopathique sont analysées. Un groupe de 177 patients qui ont été opérés pour cette affection au cours d'une période de 2 à 25 ans a été étudié. La récidive de l'affection a été constatée chez 52 d'entre eux. Chez 13 de ces patients la récidive a été transitoire; chez 19 elle a été définitive. Dans ces cas l'existence de rates accessoires a été suspectée en raison de l'absence de corpuscules de Howell-Jolly dans le sang. La scintigraphie splénique a montré leur existence dans 16 cas et 13 fois sur 15 celle-ci a été constatée lors de la réintervention. Chez 12 des sujets réopérés la thrombocytopénie a été guérie définitivement.

Resumen

Una fase importante del procedimiento de la esplenectomía es la búsqueda de bazos accesorios. La incidencia de bazos accesorios ha sido estimada en 11% como promedio. En nuestra propia experiencia con 611 pacientes sometidos a esplenectomiá por alteraciones hematológicas, se hallaron bazos accesorios en 110 casos (18%). Se revisan la anatomía quirúrgica, embriología y significatión clínica de los bazos accesorios, particularmente en referencia a la recurrencia de púrpura trombocitopénica idiopática (PTI). Se analizó el grupo de 177 pacientes con PTI esplenectomizados 2–25 años previamente. Se observé recurrencia de trombocitopenia después de una buena respuesta inmediata en 52 pacientes. En 13 casos la recurrencia fué transitoria, pero en 19 fué permanente. En tales casos se sospechó la presencia de bazos accesorios en virtud de la ausencia de cuerpos de Howell-Jolly en la sangre periférica. El bazo accesorio pudo ser demostrado por medio de la escanografía esplénica en 16 casos y su presencia confirmada en 13 de 15 pacientes reoperados. En 12 pacientes la remoción del bazo accesorio résultó en desaparicién definitiva de la trombocitopenia.

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Rudowski, W.J. Accessory spleens: Clinical significance with particular reference to the recurrence of idiopathic thrombocytopenic purpura. World J. Surg. 9, 422–430 (1985). https://doi.org/10.1007/BF01655277

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