Hypersplenism induced by hepatectomy

Background/Aims: We encountered a case of posthepatectomy splenic enlargeme nt and hypersplenism followed by disseminated intravascular coagulopathy wi th airway hemorrhage causing death. Methodology. We, therefore, retrospectively investigated postoperative sple nic enlargement, hypersplenism and disseminated intravascular coagulopathy by computed tomography and laboratory data in 57 hepatectomized patients wi th a malignant or benign disease in the postoperative period. Results: Of 32 patients with hepatocellular carcinoma or biliary tract carc inoma (group A), 12 with metastatic hepatic lesions (group B), and 13 with benign liver disease (group C); remarkable (20%) splenic enlargement was no ted in 8 patients in group A, 2 in group B, and 2 in group C. Seven of the 12 patients were associated with liver cirrhosis, 5 with preoperative splen omegaly, and 8 had undergone major hepatectomy. Postoperative hypersplenism developed in 5 patients in group A, and one patient in group C. All of the m were associated with liver cirrhosis or chronic hepatitis and preoperativ e splenomegaly, and five had undergone hepatic lobectomy or more extensive resections. All except for the disseminated intravascular coagulopathy case recovered. Statistically, splenic enlargement was significantly related to the extent of hepatectomy; lobectomy versus segmentectomy = 28.3 +/- 28.5% (n=14) versus 12.4 +/- 13.8% (n=20), (unpaired Student's (t) test, P=0.037 ). Platelet counts of the patients with liver cirrhosis or chronic hepatiti s is lower than those without the diseases, both pre- and postoperatively ( 14.0 +/- 6.0x10(4)/mm(3) vs. 21.5 +/-6.2x10(4)/mm(3), P=0.0001). Conclusions: Postoperative hypersplenism was noted only in the patients wit h liver cirrhosis or chronic hepatitis and preoperative splenomegaly, and d eveloped more frequently after larger hepatectomies than after smaller hepa tectomies; 5 (45%) of 11 versus 1 (7%) of 14, chi (2) test, P=0.026).