The Significance of Splenectomy for Advanced Proximal Gastric Cancer

Objectives. The significance of splenectomy in advanced proximal gastric cancer is examined retrospectively.Methods.From 1994 to 2004, 505 patients with advanced proximal gastric cancer underwent curative total gastrectomy with preserving spleen (T) for 264 patients and total gastrectomy with splenectomy (ST) for 241 patients.Results. Patients who underwent splenectomy showed more advanced lesions. The metastatic rate of lymph node (LN) in the splenic hilus (No. 10) in ST was 18.3%. As for the incidence of surgical complications, there was not statistically difference except for pancreatic fistula. The index of estimated benefit of (No. 10) LN was 4.2, which was similar to that of (No. 9), (No. 11p), (No. 11d), and (No. 16) LNs. 5-year survival rate of (No. 10) positive group was 22.2%. 5-year survival rates of pSE and pN2 in T group were better than that of pSE and pN2 in ST, respectively. The superiority of ST was not confirmed even in Stage II, IIIA, and IIIB.Conclusion. Splenectomy was not effective for patients with (No. 10) metastasis in long-term survival. Spleen-preserving total gastrectomy will be feasible and be enough to accomplish radical surgery for locally advanced proximal gastric cancer.

Isolated Splenic Hydatid Disease

Hydatid disease (HD) continues to be a significant health problem in areas where animal husbandry is common but no proper veterinary control exists. The involvement of the spleen in HD is rare, and isolated splenic involvement is even less common. In this case report, we present isolated splenic HD in a 26-year-old female with complaint of abdominal pain, and we discuss some of the clinical aspects of HD. Evaluation of the patient with ultrasonography, computed tomography, and magnetic resonance imaging revealed the presence of an isolated splenic HD as a multivesicular cystic mass located near splenic hilus, measuring12×11 cm. No other organ or system involvement could be demonstrated.

Gossypiboma mimicking a distal pancreatic mass: Report of a case

Gossypiboma (retained surgical sponge) is a pseudotumor within the body that is composed of non-absorbable surgical material with a cotton matrix. Because the symptoms of gossypiboma usually are nonspecific and may appear years after surgery, the diagnosis of gossypiboma may be difficult because the condition may mimic a benign or malignant soft-tissue tumour in the abdomen and pelvis. A 61-year-old woman with a one-year history of left upper-quadrant pain and weight loss was referred to our center. She had undergone peptic ulcer perforation 23 year ago. Physical examination revealed dullness and palpable mass in the left upper abdomen. On examination by computed tomography (CT), a hypodense mass of 12 cm in diameter between the greater curvature of the stomach, pancreas, and splenic hilus was detected. Upon exploration, a mass lesion of 10 cm in diameter was detected between the greater curvature of the stomach and splenic hilus, which caused dense adhesions not in communication with the pancreas. It was excised and a splenectomy was performed. After a macroscopic examination, the mass lesion was diagnosed as gossypiboma. Although ultrasonography (US), CT, angiography, and magnetic resonance imaging (MRI) may be used to diagnose gossypiboma, definitive diagnosis is possibile only upon surgery or histopathological examination. As a result, when an abdominal mass is observed, surgeons should carefully investigate the patient’s past surgical history while taking the possibility of gossypiboma into consideration.

Sonographic features of portal hypertension in Schistosomiasis Mansoni

The diagnostic value of real-time sonography in the study of portal hypertension was assessed in 66 patients with hepatosplenic schistosomiasis mansoni, all with Symmers's fibrosis and esophageal varices. Seventy-one individuals without schistosomiasis were selected as controls. The inner diameters of the portal vessels were measured by sonography in all patients and controls: splenoportography was also performed in the schistosomal group. Intra-splenic pressure was over 30 cm of water in 44 of 60 patients with schistosomiasis. The upper limit of normality for portal vessel diameters was set through receiver operating characteristic curve at 12 mm for portal vein, 9 mm for splenic vein at splenic hilus, and 9 mm for superior mesenteric vein. The best discriminative vein for the diagnosis of portal hypertension was the splenic vein followed by the portal vein. A direct correlation was observed between the diameter of the splenic vein, measured by sonography, and the intra-splenic pressure. Except for the paraumbilical and mesenteric veins, more frequently identified by sonography, there was no statistical difference in the frequency of visualization of splanchnic vessels by sonography or splenoportography.