Common complications after splenectomy
1.Intraoperative bleeding
(1) Separation of peripleural adhesions, especially when separating the spleen from the diaphragmatic surface adhesions, tearing the vascular adhesions causing more than bleeding.
(2) Blunt separation of the splenorenal ligament and tearing of the splenic vein or lateral branches of the splenic vein on the dorsal side of the splenic portal.
(3) The splenic hilum is too short and is dragged outward with excessive force, which can tear the splenic vein or put the splenic hilum.
(4) Slipping of the splenictip clamp.
(5) Short tear or avulsion of the stomach.
(6) Abnormal coagulation mechanism. It is more common in patients with poor liver function.
2. Medical proximity to organs
(1) Gastric injury, short upper splenogastric ligament, clamping or severing of splenogastric ligament or bleeding clamping of short gastric vessels to stop bleeding.
(2) Injury to the tail of the pancreas.
(3) Injury to the diaphragm.
(4) Injury to the left liver.
(5) Injury to the kidney and adrenal glands.
3.Postoperative intra-abdominal bleeding
Inadequate intraoperative hemostasis, missed bleeding points, postoperative gastric distension resulting in slippage of short gastric vascular ties, spasmodic contraction of small vessels due to shock and hypotension, postoperative clot dislodgement, occurrence of bleeding, ties cutting vessels, postoperative loosening of splenic tip ties.
Clinical manifestations of postoperative bleeding: mostly occurs within 48 hours after surgery, manifested as progressive blood pressure drop, increased pulse rate, and again, left shoulder pain may occur, and mobile turbid sounds may appear, and blood may be drawn from the abdominal puncture, or a large amount of fresh blood may be drained through the drainage tube.
4.Postoperative fever
(1) Left subphrenic fluid accumulation abscess.
Clinical manifestations are high fever, chills, excessive sweating, malaise, loss of appetite, depression, and further definite diagnosis and early drainage are required when highly suspected clinically.
(2) Left-sided pleural effusion.
(3) Postoperative pancreatic fistula.
(4) portal vein thrombosis.
(5) Splenic fever.
5.Thrombosis
Splenic vein thrombosis can be caused by blinded splenic vein formation, intraoperative splenic vein injury, and sudden postoperative platelet rise.
The clinical manifestations are: chills, high fever, abdominal pain, abdominal distension, increased ascites, jaundice, and even gastrointestinal bleeding.
6.Vicious infection after splenectomy
It occurs mostly within 2-3 years after surgery, with clinical characteristics: the disease occurs insidiously, initially with mild flu manifestations, followed by high fever, headache, nausea and vomiting, mental confusion, and even coma and shock, and death can occur within a few hours to a dozen hours. It is often complicated by diffuse intravascular coagulation and bacteraemia. The causative organism is often pneumococcus, others are Haemophilus influenzae, meningococcus, Escherichia coli, Streptococcus haemolyticus type B.
7.Hepatic coma
Causes: excessive intraoperative bleeding, shock, prolonged hypotension, prolonged surgery and anesthesia, postoperative intra-abdominal hemorrhage or ruptured hemorrhage in the fundic vein of the lower esophagus, postoperative severe infection wound dehiscence ascites leakage.
Clinical manifestations: changes in temperament or mental changes should alert the occurrence of hepatic coma. An early diagnosis of hepatic coma can be made if muscle tremor, disorientation, and disorganization of demeanor are also present. If hepatic coma is suspected, the treatment of hepatic coma should be carried out according to the treatment of hepatic coma without waiting for a clear diagnosis.
In addition to the above complications, postoperative gastrointestinal fistula, esophageal stricture, ascites, and gastroparesis may occur if peripancreatic vascular dissection is performed.