Laparoscopic Accessory Splenectomy after Open Splenectomy for Recurrent Idiopathic Thrombocytopenic Purpura

Kenichiro Uemura, Yoshiaki Murakami, Takashi Yokoyama^*, Yoshio Takesue, Yuji Imamura, Shinji Akagi, Tetsuya Kanehiro, Hiroki Ohge, Kazuya Okii and Yuichiro Matsuura

First Department of Surgery and Department of General Medicine^*, Hiroshima University, Faculty of Medicine, School of Medicine

A 40-year-old man had undergone splenectomy 8 years previously for idiopathic thrombocytopenic purpura (ITP), with a good initial clinical response. He had been under treatment with prednisolone and cyclophosphamide for thrombocytopenia for the last 3 month. Abdominal ultrasonography, computed tomography and scintigraphy showed a mass that looked like an accessory spleen in the splenic fossa near the tail of the pancreas. After laparoscopic accessory splenectomy, the medication could be discontinued, as his platelet count had increased to 37.0×10⁴/μl. This case confirms that accessory splenectomy after open splenectomy can safely be performed laparoscopically, thereby avoiding a major open procedure. The procedure should be considered as a therapeutic option for recurrent ITP, if accessory splenic tissue is seen on ultrasonography, computed tomography or scintigraphy.

Key words
idiopathic thrombocytopenic purpura, laparoscopic splenectomy, accessory spleen

Reprint requests
Kenichiro Uemura First Department of Surgery, Hiroshima University, Faculty of medicine, School of Medicine 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551 JAPAN

Accepted
July 25, 2000

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