Treatment and therapy of the consequences | Splenectomy – All you need to know about it!

Treatment and therapy of the consequences

If an infection occurs after a splenectomy, there is always the risk of a serious course of disease (OPSI) due to the missing spleen. The body must then be supported in its fight against the pathogens. For this purpose, antibiotic therapy should be initiated immediately, usually in the form of ceftriaxone, if necessary in combination with vancomycin.

Depending on the urgency, the active ingredients can be administered either by venous cannula (faster onset of action) or as tablets. Some patients are also given an antibiotic to take home after the splenectomy, which they can then take themselves in the event of fever or other systemic illness (e.g. amoxicillin or levofloxacin). However, this requires appropriate training of the patient.

If a splenectomy results in a thromboembolic event, such as leg vein thrombosis, this is usually treated with medication. The therapy then consists of heparin preparations or so-called factor X inhibitors (e.g. rivaroxaban or fondaparinux). Following the acute therapy, relapse prophylaxis in the form of coumarin derivatives (e.g. Marcumar®) is initiated over a period of several months. In the case of a pulmonary embolism, it may also be necessary to perform a drug lysis (dissolution of the blood clot) or surgical removal of the clot.

What complications can occur after a splenectomy?

With regard to complications after a splenectomy, the respiratory system is most frequently affected. Due to the increased susceptibility to infection, repeated pneumonia (pneumonia) can occur, and pleural effusions (accumulation of fluid in the gap between the chest wall and the lungs) can also occur. In about one in a hundred patients, a so-called pancreatic fistula forms as a result of the removal of the spleen, i.e. a tube-like connection of the pancreas to the intestine or abdominal cavity. Since the spleen is also responsible for the breakdown of thrombocytes (blood platelets), thrombembolic events such as thrombosis of the portal vein or leg veins occur more frequently after a splenectomy.