Hasan BESİM, Necdet ÖZÇAY, Ali ÖZANT, Kalbim ARSLAN

Postsplenektomik sepsis sendromu

Postsplenektomik sepsis sendromu, splenektomi operasyonunu takiben görülebilen ve oldukça ciddi seyreden bir klinik tablo olup operasyondan sonraki ilk iki yılda daha fazla görülmekle birlikte hayat boyu ortaya çıkabilmektedir. Travmatik splenektomiye nazaran hematolojik hastalıklar nedeni ile yapılan splenektomilerden sonra daha fazla görülmektedir. Bu makalede myelofibrozis nedeni ile splenektomi yapılan bir hastada postoperatif ikinci hafta içerisinde üst solunum yolu enfeksiyonu ile başlayan ve aylar içerisinde oldukça progresif seyrederek postsplenektomik septik şok ve multiorgan yetmezliğine bağlı exitus ile sonuçlanan bir hasta sunulmakta ve literatürle karşılaştırılmaktadır.

Anahtar Kelimeler:

Splenektomi, postsplenektomik sepsis, septik şok

Overwhelming postsplenectomy infection syndrome

Overwhelming postsplenectomy infection is a rare but serious disease that can occur after splenectomy. It is important for physicians to be familiar with it since delayed diagnosis or inadequate treatment causes high mortality. The objective of this article is to heighten awareness of physicians regarding this disease through a case report. Here we present a 70-year-old male patient who had a splenectomy for myelofibrosis. He developed recurrent upper respiratory and skin infections after splenectomy. Eventually, he died due to severe multisystem infection and having sepsis for six months postoperatively despite aggressive resuscitation and treatment. Rapid identification of patients at risk for the disease and early treatment may be the only chance to reduce the high mortality rate of this disease.

Keywords:

Splenectomy, postsplenectomy sepsis, septic shock,

PDF

___

1. Schwartz’s Principles of Surgery. In: Adrian E. Park, Rodrick McKinlay (Editors). Spleen. 8th Edition. Philadelphia, The McGraw-Hill Companies. 2005:1297-8. 2. Urata Y, Hasegawa M, Hasegawa H, et al. A fatal case of owerhelming postsplenectomy infection syndrome developing 10 years after splenectomy. Nihon Rinsho MENEKİ Gakkai Kaishi 1997;20:184-90. 3. Chu DZJ, Nishioka K, El-Hagin T, et al. Effects of tuftsin on postsplenectomy sepsis. Surgery 1985;97:701-6. 4. Zhang Y, Ma H, Cai Z. Serum tuftsin concentration as an indicator of postoperative splenic function after spleen-preserving surgery. Zhonghua Wai Ke Za Zhi 1996;34:479-81. 5. B Serio, Pezullo L, Fontana R et al. OPSI threat in hematological patients. Transl Med UniSa 2013;6:2-10. 6. Mermut G, Avcı M, Bocza B, et al. Postsplenectomy Sepsis: A Case Report. Klimik Dergisi 2010;23:64-6. 7. Okabayashi T, Hanazaki K. Overwhelming postsplenectomy infection syndrome in adults – A clinically preventable disease. World J Gastrenterol 2008;14:176-9. 8. Zarrabi MH, Rosner F. Serious infections in adults following splenectomy for trauma. Arch Intern Med 1984;144:1421-4. 9. Lutwick LI. Infections in asplenic patients. In: Mandell GL, Bennet JE, Dolin R (Editors) Bennett’s Principles and practice of Infectious diseases. 6th ed. Philadelphia: Churchill Livingstone, 2005:3524-32.