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Segmental splenic ischemia after laparoscopic sleeve gastrectomy
Surgery for Obesity and Related Diseases 11 (2015) 265–266
Images in obesity surgery
Segmental splenic ischemia after laparoscopic sleeve gastrectomy Antonio Iannelli, M.D., Ph.D.*, Anne-Sophie Schneck, M.D., Jean Gugenheim, M.D., Ph.D. Institut National de la Santé et de la Recherche Médicale (INSERM), Nice, France; Centre Hospitalier Universitaire of Nice, Digestive Center, Nice, France; University of Nice-Sophia-Antipolis, Faculty of Medecine, Nice, France Received September 21, 2014; accepted September 24, 2014
Laparoscopic sleeve gastrectomy (SG) has become a common bariatric procedure, with more than 18,000 procedures performed in France in 2013 [1]. Although staple line leak remains the most feared complication, dissection of the greater curvature may jeopardize the vascular supply to the spleen and result in a segmental splenic ischemia or infarction. A 45-year-old woman with a body mass index of 41 kg/ m2 underwent an SG. On postoperative day 3, she complained of left shoulder pain, fever (39.51C) and
tachycardia (98 beats/min). White blood cell count was 11.1 103/L, and C-reactive protein was 61 mg/dL. Computerized tomographic scan showed segmental ischemia of the upper pole of the spleen (Fig. 1). The patient was given oral amoxicillin and discharged asymptomatic on postoperative day 4, and she was asymptomatic on followup at 3 months after surgery. Segmental splenic infarction may remain completely asymptomatic, while in other cases it may be responsible
Fig. 1. Computerized tomographic scan on postoperative day 4 showing the ischemia of the upper pole of the spleen. * Correspondence: Antonio Iannelli, M.D., Ph.D., Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet 2, 151 route Saint Antoine de Ginestière, BP 3079, 06202 Nice, France. E-mail: [email protected]
http://dx.doi.org/10.1016/j.soard.2014.09.023 1550-7289/r 2015 American Society for Metabolic and Bariatric Surgery. All rights reserved.
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A. Iannelli et al. / Surgery for Obesity and Related Diseases 11 (2015) 265–266
for fever, left shoulder pain, and an increase in inflammation markers. The diagnosis is easily established by means of CT scan. In most cases, this is an entirely benign and self-resolving condition [2], but it can result in splenic abscess and/or portal vein thrombosis. References [1] French National Hospital Database (Programme De Médicalisation des Systèmes d’Information – PMSI). Available from: http://www.atih. sante.fr.
[2] Stamou KM, Menenakos E, Gomatos IP, Panousopoulos S-GD, Smparounis S, Leandros E, et al. Clinical implications of sleeve gastrectomy as a source of spleen infarction or ischemia. Obes Surg 2011;21:1490–3.
Images in obesity surgery
Segmental splenic ischemia after laparoscopic sleeve gastrectomy Antonio Iannelli, M.D., Ph.D.*, Anne-Sophie Schneck, M.D., Jean Gugenheim, M.D., Ph.D. Institut National de la Santé et de la Recherche Médicale (INSERM), Nice, France; Centre Hospitalier Universitaire of Nice, Digestive Center, Nice, France; University of Nice-Sophia-Antipolis, Faculty of Medecine, Nice, France Received September 21, 2014; accepted September 24, 2014
Laparoscopic sleeve gastrectomy (SG) has become a common bariatric procedure, with more than 18,000 procedures performed in France in 2013 [1]. Although staple line leak remains the most feared complication, dissection of the greater curvature may jeopardize the vascular supply to the spleen and result in a segmental splenic ischemia or infarction. A 45-year-old woman with a body mass index of 41 kg/ m2 underwent an SG. On postoperative day 3, she complained of left shoulder pain, fever (39.51C) and
tachycardia (98 beats/min). White blood cell count was 11.1 103/L, and C-reactive protein was 61 mg/dL. Computerized tomographic scan showed segmental ischemia of the upper pole of the spleen (Fig. 1). The patient was given oral amoxicillin and discharged asymptomatic on postoperative day 4, and she was asymptomatic on followup at 3 months after surgery. Segmental splenic infarction may remain completely asymptomatic, while in other cases it may be responsible
Fig. 1. Computerized tomographic scan on postoperative day 4 showing the ischemia of the upper pole of the spleen. * Correspondence: Antonio Iannelli, M.D., Ph.D., Service de Chirurgie Digestive et Transplantation Hépatique, Hôpital Archet 2, 151 route Saint Antoine de Ginestière, BP 3079, 06202 Nice, France. E-mail: [email protected]
http://dx.doi.org/10.1016/j.soard.2014.09.023 1550-7289/r 2015 American Society for Metabolic and Bariatric Surgery. All rights reserved.
266
A. Iannelli et al. / Surgery for Obesity and Related Diseases 11 (2015) 265–266
for fever, left shoulder pain, and an increase in inflammation markers. The diagnosis is easily established by means of CT scan. In most cases, this is an entirely benign and self-resolving condition [2], but it can result in splenic abscess and/or portal vein thrombosis. References [1] French National Hospital Database (Programme De Médicalisation des Systèmes d’Information – PMSI). Available from: http://www.atih. sante.fr.
[2] Stamou KM, Menenakos E, Gomatos IP, Panousopoulos S-GD, Smparounis S, Leandros E, et al. Clinical implications of sleeve gastrectomy as a source of spleen infarction or ischemia. Obes Surg 2011;21:1490–3.