Wockhardt Hospital, Mira Road successfully treated a patient with an enlarged spleen also called massive splenomegaly and Hypersplenism through Splenectomy
A massive 3 ft x 1 /2ft, 90 cm size spleen was removed to help the patient overcome symptoms such as abdominal tightness, pain, and fatigue eventually making it difficult to carry out day-to-day activities.
Massive splenomegaly with hypersplenism is a rare disorder that due to the enormous size of the spleen and its over-function carries risk to the patient. Enlarged spleen starts killing blood cells prematurely leading to low Haemoglobin, white cells (WBC), and platelet count. Due to severely low Haemoglobin patient had severe weakness, a low WBC count patient had poor defence mechanism which made him prone to infections, and a very low platelet count patient carries the risk of spontaneous bleeding.
MUMBAI, 7 JUNE, 2024 (TGN): A team led by Dr Imran Shaikh, Consultant GI & HPB Surgeon, Wockhardt Hospitals, Mira Road, successfully removed an enlarged spleen 3 ft x 1 1/2ft, 90 cm size weighing 8.5 kgs via surgery from a 37-year-old Bhayandar man’s abdomen. After the surgery, the patient got much-needed relief from symptoms such as abdominal tightness, pain, and fatigue eventually making him carry out day-to-day activities. Currently, the patient has been discharged from the Hospital and resumed his daily routine without any difficulty.
17 years ago, the patient Rajkumar Tiwari, was 18 years old and jolted out of his daily routine due to left-side upper abdominal pain. Despite consulting multiple doctors and undergoing thorough evaluations, his condition remained undiagnosed, and he couldn’t get any relief. His health continued to decline as his spleen enlarged, leading to symptoms like abdominal tightness, obstruction due to lack of space in the abdomen and intestines, vomiting, and even hypersplenism resulting in cytopenia from the splenomegaly. His health worsened and he was unable to carry out day-to-day activities for more than a year. The patient was referred to Wockhardt Hospitals, Mira Road by his family physician for timely intervention. After being diagnosed with splenomegaly, he found himself making frequent visits to hospitals.
Dr Imran Shaikh, Consultant GI & HPB Surgeon, Wockhardt Hospitals, Mira Road said, “On arrival in the hospital, the patient was looking weak, tired, and jaundiced. He had been severely suffering from the symptoms for more than a year but aggravated in the last month. After clinical examination, the patient was subjected to blood investigations and a CT scan to confirm the diagnosis.
The spleen is located on the left side of the abdomen and filters blood by removing old, malformed, or damaged red blood cells. However, spleen problems are seen in many people. An enlarged spleen (splenomegaly) is a common occurrence that reduces the number of healthy red blood cells, platelets, and white cells in your bloodstream, leading to frequent infections. Massive splenomegaly is called when the size of the spleen is bigger than 20 cm and weighs more than 1 kg. The most common aetiologies of massive splenomegaly include hematological disorders (chronic myeloid leukemia, agnogenic myeloid metaplasia,
polycythemia vera, essential thrombocythaemia, indolent lymphomas, hairy cell leukemia, ẞ- thalassaemia major), infectious diseases (visceral leishmaniasis, malaria) and infiltrative conditions. He has been having hypersplenism for more than a year. Consequently, his hemoglobin, white blood cells, and platelet count were reduced drastically due to an enlarged and overactive spleen. Initially, the hemoglobin used to be 7g/dL, platelet count 40000, and WBC was 4000. Recently, before surgery, Hemoglobin 5 mg%, platelet count 1000, WBC 1200, and the spleen kept on enlarging leaving no space in the abdomen and intestine. He couldn’t walk, climb sit or stand, was exhausted and bedridden, and dependent on his family members. Not treating him at the right time could have been risky leading to spontaneous bleeding. He was scheduled for Exploratory Laparotomy with Splenectomy.
Dr Imran added, “It was a very challenging task to prepare this patient for surgery. Blood and blood products given to the patient before surgery would die immediately in the spleen (A condition called Refractory hypersplenism). With a very low platelet count surgery was extremely risky with life-threatening bleeding. The patient was planned for abdominal angiography and embolization of the splenic artery. In this procedure, we block the main blood supply to the spleen by putting coils in the artery to avoid the killing of transfused blood products. Post-coiling embolization we have transfused blood products to carry out surgery and increase the safety margin for patients.
The next day surgery was done opening the abdomen. The spleen was huge-sized and was adherent to the intestines, pancreas, diaphragm, and stomach. The spleen was carefully separated from all these structures.
The operation was to remove an enlarged spleen 3 ft x 1 1/2ft, 90 cm size weighing 8.5 kg. There were no Intraoperative or postoperative complications. The surgery lasted for 6 hours. The biggest spleen removed in the world was 73.66 cm and 2.3 kgs which holds the Guinness Book World record. This patient has a spleen 90 cm sized and weighs 8.5 kg. The patient recovered uneventfully and was discharged on post-op day 5. His parameters were all fine with hemoglobin 9.6 platelet count 8,00,000 and WBC 12000 (normal). The patient recovered well. No major precautions are needed for the patient.
“The seamless coordination between various departments and cutting-edge technology ensured a successful outcome for the patient. This holistic approach combined with a relentless pursuit of excellence, has established Wockhardt Hospitals Mira Road as a trusted destination for those seeking specialized medical care. The success story of the patient serves as a testament to the Hospital’s unwavering dedication to making a positive impact on people’s lives,” said Dr. Pankaj Dhamija, Centre Head, Wockhardt Hospitals Mira Road
“Finally, after 17 long years of struggling with an enlarged spleen, the weight has been lifted off my shoulders as I underwent surgery to have it removed. The constant pain and discomfort that held me back from living a fulfilling life are now just a painful memory thanks to Dr Imran Shaikh and his team I feel like a new person with endless possibilities ahead of me. I am ready to embrace all the opportunities and adventures that come my way without the burden of physical limitations holding me back,” concluded patient Rajkumar Tiwari. ENDS/TGN
