The Journal of the Association of Physicians of India · 2019
Role of Diagnostic Splenectomy in Patients Presenting with Pyrexia of Unknown Origin with Splenomegaly and Non-Contributory Pre-surgical Evaluation.
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J Muralidharan, R Ralph, A Mathuram, V Prakash, S Nayak, A Zachariah
Аннотация
AIMS: To describe the clinical and laboratory profile, post-surgical complications and longitudinal outcomes in a historical cohort of pyrexia of unknown origin (PUO) patients with splenomegaly who underwent a diagnostic splenectomy following non-contributory extensive pre-surgical laboratory and radiological evaluation.
MATERIALS AND METHODS: This retrospective study was conducted in a 2700 bed teaching hospital in South India, in eligible patients, over a 10-year period.
RESULTS: Out of 38 PUO patients who underwent diagnostic splenectomy, a final diagnosis was established in 30 patients. Overall, infections contributed to 44 % (13/30), and neoplasia to 56% (17/30) of all cases. Of PUO patients with infections 3/13 (23%) were diagnosed with disseminated tuberculosis, 7/13 (54%) with melioidosis, 1/13 (8%) with Candidal splenic abscess with infective endocarditis and 2/13 (15%) with Colistin-resistant E. coli splenic abscess. Amongst PUO patients with neoplasia (17/30), all patients were diagnosed with hematological neoplasia. Of these 94% (16/17) were diagnosed with Non-Hodgkin's lymphoma and 6% (1/17) with Hodgkin's disease. Splenectomy was non-contributory in 21% (8/38) patients. Post-operative complications were seen in 6/38 patients who required monitoring in the intensive care unit (ICU).In-hospital mortality was noted in 10.5% (4/38) patients.
CONCLUSION: Diagnostic splenectomy has high diagnostic utility in the evaluation of PUO patients with reticuloendothelial system involvement after an extensive negative investigative workup. The diagnosis of lymphoma in such patients is more common than an infective cause.
MATERIALS AND METHODS: This retrospective study was conducted in a 2700 bed teaching hospital in South India, in eligible patients, over a 10-year period.
RESULTS: Out of 38 PUO patients who underwent diagnostic splenectomy, a final diagnosis was established in 30 patients. Overall, infections contributed to 44 % (13/30), and neoplasia to 56% (17/30) of all cases. Of PUO patients with infections 3/13 (23%) were diagnosed with disseminated tuberculosis, 7/13 (54%) with melioidosis, 1/13 (8%) with Candidal splenic abscess with infective endocarditis and 2/13 (15%) with Colistin-resistant E. coli splenic abscess. Amongst PUO patients with neoplasia (17/30), all patients were diagnosed with hematological neoplasia. Of these 94% (16/17) were diagnosed with Non-Hodgkin's lymphoma and 6% (1/17) with Hodgkin's disease. Splenectomy was non-contributory in 21% (8/38) patients. Post-operative complications were seen in 6/38 patients who required monitoring in the intensive care unit (ICU).In-hospital mortality was noted in 10.5% (4/38) patients.
CONCLUSION: Diagnostic splenectomy has high diagnostic utility in the evaluation of PUO patients with reticuloendothelial system involvement after an extensive negative investigative workup. The diagnosis of lymphoma in such patients is more common than an infective cause.