ISPUB.COM The Internet Journal of Surgery Volume 7 Number 2 1 of 5 Some Unusual Indications Of Splenectomy F Parray, N Wani, K Wani, M Wani, R Wani Citation F Parray, N Wani, K Wani, M Wani, R Wani. Some Unusual Indications Of Splenectomy. The Internet Journal of Surgery. 2005 Volume 7 Number 2. Abstract While dealing with various hematological disorders which were subjected to therapeutic splenectomy in our department of general surgery at a tertiary care centre Sher-i-Kashmir Institute of Medical Sciences over a period of more than 20 years, we came across a rare group of diseases in our set up from time to time. This rare group included 5 patients with 1. Hairy cell leukemia -1, 2 Malignant histiocytoma -1, 3 Gaucher's disease -1, 4 Tropical splenomegaly -1, and 5 Splenic hemianginoma-1. All these patients were referred to our department from the department of clinical hematology of the same institute for splenectomy for various types of cytopenias. Response to splenectomy was excellent in malignant histiocytosis, splenic hemiangioma and some of the parameters in hairy cell leukemia and Gaucher's disease, while as an unsatisfactory response was observed in tropical splenomegaly sydrome and in some of the parameters of hairy cell leukemia and Gaucher's disease. INTRODUCTION Splenectomies have been performed as early as 2,000 years ago, as per references in ancient Greek and Roman literature. The first total splenectomy for disease is attributed to Adriano-Zaccarello in 1549, although it has been suggested that the excised viscus was an ovarian cyst, clark (1676) performed splenectomy in dogs with survival. Nicholas Mathias is credited with first total splenectomy for trauma in 1678. Mayo in his retrospective study of 500 splenectomies done mainly for anemia and leukemia concluded that 80% of patients had excellent results and lived comfortably but the mortality in those days was 10% 2 . The landmark report of king and Schumacher (1952) first postulated that the spleen may play a role in resisting infection particularly in infancy 3 , but their view point was opposed by gross (1953) and Laski and Mac Millan (1959). The data given by Gross was reported in Gofstein and Gellis (1956) series of 206 cases where they concluded that there was some co-relation between splenectomy and sepsis irrespective of the age at operation. 4 However, with the advent of safe anesthesia, modern surgical technique, broad spectrum antibiotics and specific vaccines, the morbidity and mortality following splenectomy is definitely on a decline, hence more and more studies were conducted in lost 35 years in an attempt to determine the true morbidity, mortality and long term infection following splenectomy 5 , 6 , 7 , 8 . Now-a-days, role of splenectomy for various hematological disorders has definitely earned a place as a therapeutic measure especially in disorders like idiopathic thrombocytopenic purpura and hereditary spherocytosis but in diseases like sickle cell anemia, the outcome cannot be predicted with certainity 9 . Still, it is too early or impossible to estimate the risk of overwhelming post splenectomy sepsis after partial splenectomy. The people who do this procedure follow common practice guidelines that advocate immunoprophylaxis against pneumococcus, meningococcus and H-influenza as well as antibiotic prophylaxis for the child undergoing total splenectomy, although the efficiency of these measures has not been proven 10 . Given the low rate of overwhelming post-splenectomy sepsis with proper use of immunization and antibiotic prophylaxis, any risk reduction for partial splenectomy compared to total splenectomy would require a prohibitively large clinical trial. 11 MATERIAL & METHODS Our Study included patients with various hematological disorders subjected to splenectomy from July 1982 to July 2005 at Sher-i-Kashmir institute of Medical Sciences, Soura Srinagar in the department of general surgery. Medical records of all the retrospective cases were reviewed. Preoperative management of all cases included a detailed hematological and coagulation studies. Preoperative antibiotics like ampicillin and gentamycin or a third generation cephalosporin were used for prophylaxis. Corticosteroids (prednisolone) were given in the