Many patients have to have their spleen removed because of cirrhosis, hypersplenism or hematologic disorders. However, splenic fever, which often occurs after surgery, often delays the patient’s recovery, prolongs the patient’s hospital stay, and increases the patient’s costs. This is deeply troubling to splenectomy patients and clinicians.
So, what exactly is splenic fever?
Post-splenectomy fever, also known as splenic fever, is a common complication after splenectomy. Unlike the usual traumatic reaction fever in the first week after abdominal surgery, splenic fever lasts for a long time, usually 2-3 weeks, and in some cases up to several months, and the body temperature is usually about 38℃, or even up to 39℃, and the blood leukocytes are often high and fluctuating. In these patients, systemic infection should be ruled out first, followed by local infection, such as incisional infection, subdiaphragmatic infection, pulmonary infection and other common postoperative complications, which are customarily called splenic fever.
So, what are the factors that commonly cause spleen fever?
1. Accumulation of blood, fluid or infection in the splenic fossa.
Due to the large gap left in the postoperative splenic fossa, increased portal vein pressure and hypoproteinemia, fluid can often leak out; impaired coagulation mechanism caused by liver function damage, thrombocytopenia brought about by hypersplenism and increased portal vein pressure can cause blood leakage and bleeding. Fever can be produced after the accumulated blood and fluid are absorbed.
2. Intraoperative pancreatic tail injury.
Anatomically, the pancreas is closely related to the spleen, and the pancreas is located in the retroperitoneum, with the tail of the pancreas pointing to the splenic hilum; the splenic artery starts from the abdominal cavity stem and travels to the left in four segments: the superior pancreatic segment, the pancreatic segment, the anterior pancreatic segment and the splenic hilum segment. The vessels of the splenic portal segment continue to branch into the spleen, with 30% branching 0.6-2cm from the splenic portal and 70% branching 2.1-6em from the splenic portal. A gap is palpated with the finger immediately adjacent to the splenic hilum, which is the secondary splenic hilum. Removal of the spleen is likely to cause injury to the tail of the pancreas and result in postoperative pancreatic leakage, which is considered to be one of the main causes of postoperative splenic fever, especially in traditional splenectomy, i.e., the bundled splenic ligature method, which usually uses three splenic ligatures to directly clamp the splenic ligature in the treatment of the splenic ligature, ignoring the existence of the secondary splenic ligature gap; whereas the “bundled splenic ligature method” can largely avoid injury to the splenic ligature when dealing with the splenic ligature. In contrast, the “split splenic ligation” method can largely avoid damage to the tail of the pancreas and prevent pancreatic leakage, thus reducing splenic fever.
3. Thrombophlebitis may occur after portal splenic vein thrombosis, and fever may occur.
4. The spleen is an immune organ.
Fever can be caused after splenectomy because of the following three reasons.
(1) The role of detoxification, filtration and decomposition of heterogeneous proteins of the spleen cannot be replaced by other reticuloendothelial system in the short term, the immune protection and self-stabilization function of the organism decreases, and the ability to process and remove macromolecular substances and antigens decreases, resulting in some thermogenic substances (especially endogenous thermogenic sources, mainly through lymphokines stimulating large monocytes to produce endogenous thermogenesis causing fever) cannot be effectively and completely inactivated and
(2) Decrease in the number of seedlings and phagocytosis of liver Kupffer cells, so that blood from the intestine containing microorganisms and food antigens cannot be cleared by the liver, which stimulates the immune system and causes fever and is significantly correlated with liver function grading.
(3) The body’s ability to form specific antibodies and remove specific antigenic substances is reduced, immunoglobulins are reduced, the production of complement, regulators and phagocytosis hormones are impaired, the body’s defense ability against infection is reduced, so that the body cannot effectively inactivate and remove endogenous pyrogen, the latter acts on the thermoregulatory center, causing the thermoregulatory point to rise and the body temperature to rise. Therefore, the application of antibiotics is often ineffective.
5. The hepatic blood perfusion pressure will produce changes in hepatocyte function causing fever, etc..
If there is splenic fever, the general application of antibiotics will have limited efficacy. If there is no obvious sign of infection in the blood check, antibiotics should be stopped decisively and only non-steroidal drugs or hormones should be applied to reduce fever. Usually after 2-3 weeks, spleen fever will gradually reduce and disappear.
Spleen fever can be seen to have the following characteristics.
1. persistent and fluctuating.
2. Exclusion: various infectious factors are excluded.
3.Self-healing: It often resolves on its own, independent of antibiotic application.
4.Vagueness: the cause is often unclear, often related to splenic fossa exudation, absorption fever, splenic vein thrombosis, immune deficiency, liver function abnormalities, and other factors.