17 years ago, patient Rajkumar Tiwari had to give up 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.
After struggling for almost two decades, Tiwari recently got treated by a team led by Dr Imran Shaikh, consultant GI & HPB surgeon, Wockhardt Hospitals, Mira Road, who successfully removed an enlarged spleen 3 ft x 1 ½ft, 90 cm size weighing 8.5 kgs via surgery.
Shaikh remarks “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 prevalent 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.
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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. An enlarged spleen starts killing blood cells prematurely leading to low haemoglobin, white cells (WBC), and platelet count. Due to severely low haemoglobin Tiwari had severe weakness, a low WBC count patient a poor defense mechanism that made him prone to infections.
Consequently, his hemoglobin, white blood cells and platelet count were reduced drastically due to an enlarged and overactive spleen. 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.
Shaikh adds, “It was very challenging 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.”
Next day, the surgery was done by 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.
Healthcare experts report that 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 kg which holds the Guinness Book World record. This patient has a spleen 90 cm sized and weighs 8.5 kg. The patient recovered and was discharged on post-op day 5. His parameters read fine with hemoglobin 9.6 platelet count 8,00,000 and WBC 12000 (normal).
Tiwari shares that ‘The constant pain and discomfort that held me back from living a fulfilling life are now just a painful memory thanks to the team of healthcare professionals.”
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