Cite this page: Mansouri J. Splenectomy, rupture & splenosis. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/spleensplenectomy.html. Accessed December 22nd, 2024.
Splenectomy
Definition / general
- Usually performed for traumatic rupture
- Usually no clinical consequence in adults but elevated risk of infection is present, especially in elderly and those with malignancy (Med J Aust 2012;196:582)
- In children, associated with increased incidence and severity of infections, particularly encapsulated bacteria such as Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae; overwhelming infections (OPSI: overwhelming postsplenectomy infection) may begin days to years after splenectomy, without an identifiable focus and have 50 - 80% mortality despite antibiotics
- Increased susceptibility to severe infections with intraerythrocytic parasites Babesia and Plasmodium (Clin Microbiol Rev 2010;23:740)
- In children, splenectomy is avoided in favor of splenic repair, partial splenectomy or splenic autotransplant
- Must consider possibility of accessory spleen(s) if splenectomy is performed for hematologic disorders
Laboratory
- Howell-Jolly bodies are evidence of no splenic function
Case reports
- 2 cases of postsplenectomy pneumococcemia (Arch Pathol Lab Med 1980;104:258)
Peripheral smear images
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Howell-Jolly bodies
Rupture
Definition / general
- Due to blunt trauma or abdominal surgery, causing hemoperitoneum and emergency splenectomy
- Only rarely ruptures spontaneously (associated with acute splenitis, amyloidosis [rare], infectious mononucleosis, inflammatory disorders, leukemia / lymphoma, malaria, other tumors, peliosis lienis, pregnancy, subacute bacterial endocarditis, typhoid fever)
- Splenic rupture may be delayed after trivial / minor trauma
Case reports
- 16 year old girl with infectious mononucleosis (Int J Surg Case Rep 2012;3:97)
- 29 year old woman with splenic pregnancy (Arch Pathol Lab Med 2004;128:e146)
- 54 year old woman with systemic lupus erythematosus (Clin Rheumatol 2012;31:1019)
- 2 patients with pancreatic cancer presenting with splenic rupture (Arch Pathol Lab Med 2004;128:1146)
Clinical images
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Grossly enlarged with hematoma
Gross description
- Rupture may be a very small capsular tear, often in superior pole or hilum
Microscopic (histologic) description
- Neutrophils below capsular tear with intraparenchymal hemorrhage; also lymphoid hyperplasia with prominent marginal zone
Additional references
Splenosis
Definition / general
- Autotransplantation of splenic tissue on peritoneal surface, abdominal wall or elsewhere after rupture or splenectomy
- Usually affects young men
- Common; may affect 67% of those with trauma to spleen
- May also implant within pleural cavity, lung parenchyma or brain
Case reports
- 20 year old man with cerebral splenosis 15 years after posttraumatic splenectomy (Am J Surg Pathol 1998;22:894)
- 49 year old woman with abdominal splenosis mimicking colon and liver tumors (Int J Med Sci 2012;9:174)
Clinical images
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Autotransplantation
spleen tissues
Microscopic (histologic) description
- Red and white pulp, resembling accessory spleen
Differential diagnosis
