Mumbai: A team led by Dr Imran Shaikh, Consultant GI & HPB Surgeon, Wockhardt Hospitals, Mira Road, successfully removed an enlarged spleen (3 ft x 1 ½ft, 90 cm) weighing 8.5 kg 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 a 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 Shaikh 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 patient had hypersplenism for more than a year. Consequently, his haemoglobin, white blood cells, and platelet count were reduced drastically due to an enlarged and overactive spleen. Initially, the haemoglobin used to be 7g/dL, the platelet count was 40000, and the WBC was 4000. Recently, before surgery, haemoglobin was 5 mg per cent, platelet count was 1000, and WBC was 1200, and the spleen kept on enlarging, leaving no space in the abdomen and intestine. The patient couldn’t walk, climb, sit, or stand; he was exhausted, 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 and 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 embolisation 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 embolisation 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 large 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, there were no intraoperative or postoperative complications. The surgery lasted for six hours. The biggest spleen removed in the world was 73.66 cm and 2.3 kg, which holds the Guinness Book World record. This patient had a spleen 90 cm in size and weighed 8.5 kg. The patient recovered uneventfully and was discharged on post-op day five. His parameters were all fine, with haemoglobin 9.6, platelet count 8,00,000, and WBC 12000 (normal). The patient recovered well. No major precautions were needed for the patient.

“The seamless coordination between various departments and cutting-edge technology ensured a successful outcome for the patient,” said Dr Pankaj Dhamija, Centre Head, Wockhardt Hospitals, Mira Road.

  • Published On Jun 7, 2024 at 06:05 PM IST

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