Diagnostic Splenectomy in Patients with Fever of Unknown Origin and Splenomegaly
- 28 February 2008
- journal article
- research article
- Published by S. Karger AG in Acta Haematologica
- Vol. 119 (2), 83-88
- https://doi.org/10.1159/000118632
Abstract
Objective: To review the diagnostic significance, safety and possible risk factors of splenectomy in fever of unknown origin (FUO) with splenomegaly. Methods: The records of 54 patients with FUO and splenomegaly who underwent splenectomy in our hospital in the past 20 years were reviewed retrospectively. Pathologic findings, morbidity, mortality and possible risk factors were analyzed. Results: Histologic findings included 29 cases of non-Hodgkin lymphoma, 4 cases of spleen tuberculosis, 3 cases of Hodgkin lymphoma, 1 case of Castleman disease and 2 cases of hemophagocytic syndrome. An etiologic diagnosis was made in 72.2% of the patients undergoing splenectomy. Surgical complications occurred in 25.9% of the patients and 1-month operative mortality was 16.7%. The mortality rate 1 month after surgery was significantly associated with serous cavity effusion (46.2 vs. 7.5%, p = 0.006) and spleen weight >1,500 g (50.0 vs. 9.1%, p = 0.007). There was no significant difference in the mortality rate of the patients with or without jaundice, pancytopenia, elevated serum alanine aminotransferase (ALT) or elevated LDH (p > 0.5). Multivariate analysis revealed serous cavity effusion (odds ratio 21.0; 95% confidence interval 2.2–212.8; p = 0.01) and spleen weight >1,500 g (odds ratio 18.0; 95% confidence interval 1.9–173.8; p = 0.01) as independent risk factors. Conclusion: Splenectomy is an effective diagnostic modality for FUO presenting with splenomegaly. The presence of serous cavity effusions and spleen weight >1,500 g identifies patients with the greatest operative risk.Keywords
This publication has 14 references indexed in Scilit:
- From Prolonged Febrile Illness to Fever of Unknown OriginArchives of Internal Medicine, 2003
- Laparoscopic approach to fever of unknown originSurgical Endoscopy, 2003
- World Health Organization Classification of Neoplastic Diseases of the Hematopoietic and Lymphoid Tissues: Report of the Clinical Advisory Committee Meeting—Airlie House, Virginia, November 1997Journal of Clinical Oncology, 1999
- Laparoscopic or Open Splenectomy for Hematologic Disease: Which Approach Is Superior?Journal of the American College of Surgeons, 1997
- Laparoscopic Splenectomy and Lymph Node Biopsy for Hematologic DisordersAnnals of Surgery, 1995
- A Predictive Model for Aggressive Non-Hodgkin's LymphomaNew England Journal of Medicine, 1993
- Was leistet die Laparoskopie bei der Klärung von Fieber unbekannter Ursache?Deutsche Medizinische Wochenschrift (1946), 1987
- FEVER OF UNEXPLAINED ORIGIN: REPORT ON 100 CASESMedicine, 1961