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Is There Any Alternate Option To Splenectomy For Treating Hypersplenism?
Question: my patient suffering from thrombocytopenia as per doctors advise suggested for splenectomy due to spleenomegaly (detected by CT porto graphy) and partial blokage of left and right portal vein, pateient aged 32 years healthy non alcoholic, non smoker, having brain haemorrage with 3.2 X 3.1 cm bleeding, condition is stable platelets count varies from 23000 to 64000 and there is continuous flactuation. other test reports like ANA - Negative, Ceruloplasmin - 22.5, high bilurubin, endoscopy reveals normal.
my question is
1. is there surgery is the only option?
2. is there any option to control platelets destruction
3. can we remove partial blockage through medicines
4. can spleenomegaly is revarsal?
my question is
1. is there surgery is the only option?
2. is there any option to control platelets destruction
3. can we remove partial blockage through medicines
4. can spleenomegaly is revarsal?
Brief Answer:
Splenectomy or proximal splenorenal shunt operation.
Detailed Answer:
Hi,
I have gone through your question. I can understand your concern.
This patient has portal hypertension and hypersplenism. Due to hypersplenism there is pooling of platelets cells and it leads to low platelet count and intracranial bleeding with paralysis.
He should take treatment of hypersplenism and portal hypertension. In this type of cases splenomegaly is non reversible most of the time. And surgery is the only option in hypersplenism because it is associated with non cirrhotic portal hypertension.
Option to control platelet destruction is either splenectomy or shunt operation. Further medical / conservative treatment may not always treat blocks.
There this patient should take treatment for hypersplenism first. It leads to stabilisation in the platelet count and prevent further bleeding. Since he also has non cirrhotic portal hypertension it needs to be treated as well. Therefore splenectomy or proximal splenorenal shunt operation is the treatment of choice.
Regards
Splenectomy or proximal splenorenal shunt operation.
Detailed Answer:
Hi,
I have gone through your question. I can understand your concern.
This patient has portal hypertension and hypersplenism. Due to hypersplenism there is pooling of platelets cells and it leads to low platelet count and intracranial bleeding with paralysis.
He should take treatment of hypersplenism and portal hypertension. In this type of cases splenomegaly is non reversible most of the time. And surgery is the only option in hypersplenism because it is associated with non cirrhotic portal hypertension.
Option to control platelet destruction is either splenectomy or shunt operation. Further medical / conservative treatment may not always treat blocks.
There this patient should take treatment for hypersplenism first. It leads to stabilisation in the platelet count and prevent further bleeding. Since he also has non cirrhotic portal hypertension it needs to be treated as well. Therefore splenectomy or proximal splenorenal shunt operation is the treatment of choice.
Regards
Above answer was peer-reviewed by :
Dr. Prasad
Dear Sir,
Thanks for the reply and further we want certain query, As per your mail there is two option to control platelets first treatment and second option surgery
(1) Please suggest if any medicine available to control portal hypertension and spleenomegaly.
(2) What is shunt operation and chances of recovery with advantage and disadvantage.
(3) Future complication after spleenectomy.
(4) If operation is final solution then which operation is best option like spleenectomy of shunt operation.
Thanks for the reply and further we want certain query, As per your mail there is two option to control platelets first treatment and second option surgery
(1) Please suggest if any medicine available to control portal hypertension and spleenomegaly.
(2) What is shunt operation and chances of recovery with advantage and disadvantage.
(3) Future complication after spleenectomy.
(4) If operation is final solution then which operation is best option like spleenectomy of shunt operation.
Brief Answer:
You should go for proximal splenorenal shunt surgery along with splenectomy
Detailed Answer:
Hi, dear
I have gone through your question. I will give you answers one by one.
1. Propranolol can be used to control portal hypertension. But it has many side effects and less commonly used in non cirrhotic portal hypertension with hypersplenism.
2. In shunt operation anastomosis of splenic vein and left renal vein is done. It relieve the portal hypertension also and later on chances of varicial bleeding due to portal hypertension is reduced. Splenectomy alone can relieve hypersplenism but it can not relieve portal hypertension. Spelenctomy with shunt operation operation has this advantage. Chance of recovery and long term prognosis is good.
3. Early Complication after spelenectomy are respiratory tract infection and subphrenic abscess.
Late complications are post splenectomy sepsis syndrome and infections with pnumococci, H influenza, meningococci and group A streptococci.
4. Operation is the final treatment of choice. According to my opinion you should not go for splenectomy alone. You should go for spelenectomy along with proximal splenorenal shunt operation. It will relieve hypersplenism and portal hypertension both.
Hope I have answered your question. if you have any doubts then feel free to ask me. I will be happy to answer.
Thanks for using health care magic.
Wish you a very good health.
You should go for proximal splenorenal shunt surgery along with splenectomy
Detailed Answer:
Hi, dear
I have gone through your question. I will give you answers one by one.
1. Propranolol can be used to control portal hypertension. But it has many side effects and less commonly used in non cirrhotic portal hypertension with hypersplenism.
2. In shunt operation anastomosis of splenic vein and left renal vein is done. It relieve the portal hypertension also and later on chances of varicial bleeding due to portal hypertension is reduced. Splenectomy alone can relieve hypersplenism but it can not relieve portal hypertension. Spelenctomy with shunt operation operation has this advantage. Chance of recovery and long term prognosis is good.
3. Early Complication after spelenectomy are respiratory tract infection and subphrenic abscess.
Late complications are post splenectomy sepsis syndrome and infections with pnumococci, H influenza, meningococci and group A streptococci.
4. Operation is the final treatment of choice. According to my opinion you should not go for splenectomy alone. You should go for spelenectomy along with proximal splenorenal shunt operation. It will relieve hypersplenism and portal hypertension both.
Hope I have answered your question. if you have any doubts then feel free to ask me. I will be happy to answer.
Thanks for using health care magic.
Wish you a very good health.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Dear Sir,
Thanks for your valuable suggestion and kind reply.Sir herewith attaching doctor advise for the medicine and requesting you for your valuable suggestion on this.
Levipil- 500mg BD
Tetrafol pls-1 tab at bed time
Strocit-500mg -BD
Duphalac-20ml at bed time
my question - can we keep patient for atleast 2-3 month and after 2-3 month we can plan for the operation
Awaiting your valuable reply
with sincere regards
Dr D D DUBEY
Thanks for your valuable suggestion and kind reply.Sir herewith attaching doctor advise for the medicine and requesting you for your valuable suggestion on this.
Levipil- 500mg BD
Tetrafol pls-1 tab at bed time
Strocit-500mg -BD
Duphalac-20ml at bed time
my question - can we keep patient for atleast 2-3 month and after 2-3 month we can plan for the operation
Awaiting your valuable reply
with sincere regards
Dr D D DUBEY
Brief Answer:
You can wait for some time.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
I will explain about drugs in detail.
Levipil contains levetiracetam. It is used to control seizures. You have intracranial hemorrhage and seizures. Levipil is given to control further seizures.
Tetrafol contain folic acid. it is vitamin supplements.
Strocit contain citicoline. It is used in stroke recovery patients.
Citicoline seems to increase a brain chemical called phosphatidylcholine. This brain chemical is important for brain function. Citicoline might also decrease brain tissue damage when the brain is injured.
Duphalac is used to prevent the complication of hepatic encephalopathy. You have portal hypertension so chance of hepatic encephalopahty is there. Duphalac will take care of that.
You can wait for some times there is no harm in that. But regular monitoring of platelet count should be done. And in case of any bleeding urgent surgery may needed. It will depends on general condition of patient and many other factor.
I would like to advise that you should discuss with your treating doctor. Take decision accordingly.
Hope I have answered your questions. if you still have any other doubts then feel free to ask me.
Thanks for using health care magic. Wish you a very good health.
You can wait for some time.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
I will explain about drugs in detail.
Levipil contains levetiracetam. It is used to control seizures. You have intracranial hemorrhage and seizures. Levipil is given to control further seizures.
Tetrafol contain folic acid. it is vitamin supplements.
Strocit contain citicoline. It is used in stroke recovery patients.
Citicoline seems to increase a brain chemical called phosphatidylcholine. This brain chemical is important for brain function. Citicoline might also decrease brain tissue damage when the brain is injured.
Duphalac is used to prevent the complication of hepatic encephalopathy. You have portal hypertension so chance of hepatic encephalopahty is there. Duphalac will take care of that.
You can wait for some times there is no harm in that. But regular monitoring of platelet count should be done. And in case of any bleeding urgent surgery may needed. It will depends on general condition of patient and many other factor.
I would like to advise that you should discuss with your treating doctor. Take decision accordingly.
Hope I have answered your questions. if you still have any other doubts then feel free to ask me.
Thanks for using health care magic. Wish you a very good health.
Above answer was peer-reviewed by :
Dr. Shanthi.E
Dear Sir,
Thanks for the reply
sir as per your suggestion we will wait for some time and regular monitor platelets count. Platelets count we are monitoring everyday and there is significant increase the number of platelets from 27th to till date, please find date wise platelets count
27th- 58000
28-57000
29th- 84000
30th 164000
above data is showing there is improvement of platelets count and coming to normal level.
My question
(1) Can we expect spleen improvement.
(2) can we expect long-term improvement of platelets.
with regds
Dr.D.D.DUBEY
Thanks for the reply
sir as per your suggestion we will wait for some time and regular monitor platelets count. Platelets count we are monitoring everyday and there is significant increase the number of platelets from 27th to till date, please find date wise platelets count
27th- 58000
28-57000
29th- 84000
30th 164000
above data is showing there is improvement of platelets count and coming to normal level.
My question
(1) Can we expect spleen improvement.
(2) can we expect long-term improvement of platelets.
with regds
Dr.D.D.DUBEY
Brief Answer:
It can occur but chances are less.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
Its very good that your platelet count is improving.
Long term chance of improvement in spleen size is very low. But it can occur in few cases. If your platelets count remains normal then you can wait for surgery and by that time you can go for ultrasound abdomen to check the spleen size. If it decreases then its very good. But if it remains as it is or further increase then you have to go for surgery.
Long term platelet count improvement in hypersplenism is uncommon.
According to my opinion you should go for surgery. You can wait but it is the treatment of choice.
Hope I have answered your question, if you have doubt then I will be happy to answer.
Thanks for using health care magic.
Wish you a very good health.
It can occur but chances are less.
Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
Its very good that your platelet count is improving.
Long term chance of improvement in spleen size is very low. But it can occur in few cases. If your platelets count remains normal then you can wait for surgery and by that time you can go for ultrasound abdomen to check the spleen size. If it decreases then its very good. But if it remains as it is or further increase then you have to go for surgery.
Long term platelet count improvement in hypersplenism is uncommon.
According to my opinion you should go for surgery. You can wait but it is the treatment of choice.
Hope I have answered your question, if you have doubt then I will be happy to answer.
Thanks for using health care magic.
Wish you a very good health.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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