Prophylaktische Splenektomie während Resektion bei chronischer Pankreatitis

Abstract

Complications of prophylactic splenectomy are rare and less frequent than reported episodes of variceal bleeding. In the presence of asymptomatic SVT splenectomy should be considered during pancreatic resection to facilitate surgery and to avoid further variceal bleeding.

Natural history of pancreatitis-induced splenic vein thrombosis: a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding

“…For example, between 1969 and 1984, 45% of patients reported with PISVT initially presented with GI bleeding 7 . Similarly, removing the limit on study age in the literature included in this analysis yields an overall PISVT incidence of 14.1% (22.6% in AP and 12.4% in CP) and a bleed rate of 19.0% 2,3,6,7,9,11–14,17–45 . A comparison of these data with results reported in the current review indicates both an increasing awareness of PISVT and a decreasing concern for GI bleed in the era of universal cross‐sectional imaging.…”

“…A meta‐analysis of contemporary studies meeting inclusion criteria showed an overall mean reported incidence of PISVT of 14.1% (Figure 5). 11,13,17,25–29,36 Mean incidences varied from 22.6% in patients with AP to 12.4% in patients with CP. The incidence of associated splenomegaly was only 51.9% 3,6,7,9,11,13,18,19,24,26,28,36,42,46 .…”

“…After duplicates had been removed and the exclusion criteria noted in Table 2 applied, 47 clinical studies and 52 case reports were graded as relevant; these referred to a cohort of 805 distinct patients with PISVT. Thirty‐eight references were assessed as eligible for quantitative inclusion by the reviewers 2,3,6,7,9,11–14,17–45 . The median CEBM level of included studies was 2A 15 .…”

Prevalence of splenic vein thrombosis and risk of gastrointestinal bleeding in chronic pancreatitis patients attending a tertiary hospital in western India

“…[292122] SAE can also be performed prior to splenectomy to decrease arterial flow into the left portal system. [42324] Splenectomy and SAE interrupt the arterial supply to the feeding collateral veins and thus decompressing gastric varices and consequently reduced risk of variceal re-bleeding. [31525]…”