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ABSITE - Spleen Questions and Answers
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A 29-year-old female with hereditary spherocytosis is recommended to undergo splenectomy. At what time point is trivalent immunization recommended? A. 1-month pre-op B. 2-weeks pre-op C. 1-week pre-op D. 1-week post-op E. 2-weeks post-op  :-- 2-weeks pre-op Correct. Although rare, over...

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  • August 28, 2024
  • 24
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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  • absite spleen questions and answers

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  • ABSITE
  • ABSITE

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ABSITE - Spleen Questions and Answers
A 29-year-old female with hereditary spherocytosis is recommended to undergo splenectomy.

At what time point is trivalent immunization recommended?

A. 1-month pre-op

B. 2-weeks pre-op

C. 1-week pre-op

D. 1-week post-op

E. 2-weeks post-op


 :-- 2-weeks pre-op

Correct.

Although rare, overwhelming post-splenectomy infection (OPSI) is a life-threatening

complication that can occur weeks, months, or years following splenectomy. Encapsulated

organisms such as Haemophilus, Streptococcus pneumoniae, and Meningococcus are most

commonly responsible. The Centers for Disease Control and Prevention recommends

vaccination against these three organisms 2 weeks prior to elective splenectomy.




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The risk of dying from overwhelming post-splenectomy infection (OPSI)

A. is greatest after splenectomy for trauma.

B. decreases as the interval after splenectomy increases.

C. is greatest in the elderly.

D. eventually becomes identical to the risk in the normal population.

E. is eliminated by taking prophylactic penicillin.


 :-- decreases as the interval after splenectomy increases.

Correct.

An increased risk of sepsis and septic shock is directly related to splenectomy at any age.

Children less than 15 years of age have a greater overall risk of developing overwhelming post-

splenectomy infection (OPSI) compared with adults (0.13% to 8.1% versus 0.28% to 1.9%).

Splenectomized infants and young children are even more susceptible for pneumococcal sepsis.




The incidence of OPSI is related to the underlying disease. Historically the incidence of sepsis

after splenectomy caused by trauma is lower than after splenectomy for hematologic disorders or

malignancy. Increased mortality is also seen in patients with lymphoreticular disease, and in those

undergoing extensive chemotherapy and radiation therapy.




Published information indicates that most cases of OPSI present in the initial two years after

splenectomy, with 50% to 80% within this period. The mortality of OPSI is 50% or greater. The




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risk of OPSI is lifelong, and OPSI has been reported more than 40 years after operation.

Prophylactic penicillin is of no proven benefit.




You are consulted on a 55-year-old homeless woman admitted for sepsis with documented

gram-positive bacteremia. A CT scan of the abdomen obtained today is shown below (multifocal

abscesses). She has been started on broad-spectrum antibiotics. What is the most appropriate

next step in her management?




A. Mesenteric angiography and embolization

B. Image-guided percutaneous drain placement

C. Splenectomy

D. Fine needle aspiration and culture of splenic lesions

E. Administration of IgG


 :-- Splenectomy

Correct.

The image demonstrates multiple splenic abscesses likely seeded from the patient's bacteremia

producing septic emboli. Optimal treatment is splenectomy. Image-guided drain placement may

be an option for a marginally stable patient with a single abscess, but is prone to failure and

complication. IgG is typically used in the treatment of ITP, not splenic abscess. FNA and culture

plays no role in the treatment of this disease process.




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