Pre- and Postoperative Care for Surgical Procedures on the Spleen

Author(s): Mircea Dan Venter

Pp: 201-216 (16)

DOI: 10.2174/978160805273811101010201

* (Excluding Mailing and Handling)

Abstract

Due to associated diseases, the function of the spleen may be modified, in turn causing certain complications, such as anaemia, altered coagulation, malnutrition and organ failure. Preoperative management of patients must take these two possibilities into account. In non-traumatic splenectomies, blood samples are necessary to screen for thrombophilia: antithrombin III deficiency, protein C deficiency, protein S deficiency and dysplasminogenemia. Complete blood count, AST, ALT, serum amylase, C-reactive protein, thrombin-AT-III complex and D-dimer also become necessary perioperatively. The preoperative management of anaemia must evaluate the risk and benefits of blood transfusion. Malnutrition increases the risk of postoperative complications. Antibiotics are recommended for patients who are immunosuppressed and in trauma. In the classical form of spleen surgery, pain is a frequent symptom, with variable intensity, mostly due to the pressure applied to the ribs. If the pain is not well managed by specific pills, it is better to make an anaesthetic block of the thoracic nerves. Thrombosis extending into the portal vein is rare; with an overall risk of 3.3%. Infection is the most common postoperative complication. Fever commonly appears between the fourth and seventh day after surgery. The risk of thromboembolic events and pulmonary arterial hypertension varies greatly, depending on the underlying condition for which the splenectomy is performed and its association with intravascular haemolysis. The most serious septic complication after splenectomy is the (OPSI), which brings about a prohibitory mortality rate of 50% to 90%. Prevention of postsplenectomy sepsis has occurred through the use of greater efforts to avoid splenectomies.

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      • 13. app/Models/UserAccess/UserAccess.php:1266
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      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 58766425 and j.to_ip >=58766425 )) and ((j.from_date <= 1740776170 and j.to_date >= 1740776170 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 2398) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 58766425 and j.to_ip >=58766425 )) and ((j.from_date <= 1740776170 and j.to_date >= 1740776170 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 2398) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 58766425 and j.to_ip >=58766425 )) and ((j.from_date <= 1740776170 and j.to_date >= 1740776170 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 2398)
      900μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 956 and `b`.`banner_from_date` <= 1740776170 and `b`.`banner_to_date` >= 1740776170 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.55msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 956
      • 3: 1740776170
      • 4: 1740776170
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='6f56825e1f8ec2a4e634571f22e84df9'
      330μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:291
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Keywords
    1Keywords.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        kmbflYHJf9F3qp1nUGVPonvb4X6ZSzhuMCMlaHEC
        uc_cart_id
        6f56825e1f8ec2a4e634571f22e84df9
        _previous
        array:1 [ "url" => "http://alpha.eurekaselect.com/chapter/2398" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/2398
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:8 [ "accept-encoding" => array:1 [ 0 => "gzip, deflate" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] "connection" => array:1 [ 0 => "keep-alive" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] ]
        request_cookies
        []
        
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Fri, 28 Feb 2025 20:56:10 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6InNSbzl1NlMycGFxbTdMWUVzUTFQWkE9PSIsInZhbHVlIjoiS0dDT2pKRkNrN3hHaE5YVkVoL1NBQ29pRCswd2tuSVh6azIxOWlhdk9jSFhERUtqVjR0VnFKRnNuOTJVK2l6ZTBzVkpiKzVnd1MyUFhMRTRmRWpyMzV2VnVvMUhQdUY1bit6b3F0WGRMcVdOaE9Pa0xMRWJMOVEra3RtTk1IVVYiLCJtYWMiOiI1MTczNjk5ZjZjOTYwMDNhNjA5ZGEyMmNiMzk1MDY1MGI2MWFjMzIwYzQ3ODM2NTA2OWIzZGUzMTg1MGY4NGJlIiwidGFnIjoiIn0%3D; expires=Mon, 03 Mar 2025 08:56:10 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6InNSbzl1NlMycGFxbTdMWUVzUTFQWkE9PSIsInZhbHVlIjoiS0dDT2pKRkNrN3hHaE5YVkVoL1NBQ29pRCswd2tuSVh6azIxOWlhdk9jSFhERUtqVjR0VnFKRnNuOTJVK2l6ZTBzVkpiK" 1 => "alphaeurekaselectnet_session=eyJpdiI6IkhBNXNUOHBVb2VNY0N6UmVvN3plQlE9PSIsInZhbHVlIjoiWFF0WTVEdHB0NUY0T1BJb24xdnEzMG05MWQxWk9aRmFLc2ZKS25FYjBpRXVlQm1nRXpoR0VBRDEzakhacVZhMCtRZmtsTk1mcEhNNXpZU090cTF6RDd2M3E1Y05yRjhHcENxUnZhMWxHQVR4V2pBTmFkY3o5b1NyNGRXSkZ5NU8iLCJtYWMiOiJlYTFkZjk2ZWRmYjhmOTY2Y2Y2OTI1OTNhZTFkMjczY2Y3Yjg2ZGEzOWE5MWYzZDZkNDEyMmRlYzc5NzUzMjk0IiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6IkhBNXNUOHBVb2VNY0N6UmVvN3plQlE9PSIsInZhbHVlIjoiWFF0WTVEdHB0NUY0T1BJb24xdnEzMG05MWQxWk9aRmFLc2ZKS25FYjBpRXVlQm1nRXpoR0VBRDE" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6InNSbzl1NlMycGFxbTdMWUVzUTFQWkE9PSIsInZhbHVlIjoiS0dDT2pKRkNrN3hHaE5YVkVoL1NBQ29pRCswd2tuSVh6azIxOWlhdk9jSFhERUtqVjR0VnFKRnNuOTJVK2l6ZTBzVkpiKzVnd1MyUFhMRTRmRWpyMzV2VnVvMUhQdUY1bit6b3F0WGRMcVdOaE9Pa0xMRWJMOVEra3RtTk1IVVYiLCJtYWMiOiI1MTczNjk5ZjZjOTYwMDNhNjA5ZGEyMmNiMzk1MDY1MGI2MWFjMzIwYzQ3ODM2NTA2OWIzZGUzMTg1MGY4NGJlIiwidGFnIjoiIn0%3D; expires=Mon, 03-Mar-2025 08:56:10 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6InNSbzl1NlMycGFxbTdMWUVzUTFQWkE9PSIsInZhbHVlIjoiS0dDT2pKRkNrN3hHaE5YVkVoL1NBQ29pRCswd2tuSVh6azIxOWlhdk9jSFhERUtqVjR0VnFKRnNuOTJVK2l6ZTBzVkpiK" 1 => "alphaeurekaselectnet_session=eyJpdiI6IkhBNXNUOHBVb2VNY0N6UmVvN3plQlE9PSIsInZhbHVlIjoiWFF0WTVEdHB0NUY0T1BJb24xdnEzMG05MWQxWk9aRmFLc2ZKS25FYjBpRXVlQm1nRXpoR0VBRDEzakhacVZhMCtRZmtsTk1mcEhNNXpZU090cTF6RDd2M3E1Y05yRjhHcENxUnZhMWxHQVR4V2pBTmFkY3o5b1NyNGRXSkZ5NU8iLCJtYWMiOiJlYTFkZjk2ZWRmYjhmOTY2Y2Y2OTI1OTNhZTFkMjczY2Y3Yjg2ZGEzOWE5MWYzZDZkNDEyMmRlYzc5NzUzMjk0IiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6IkhBNXNUOHBVb2VNY0N6UmVvN3plQlE9PSIsInZhbHVlIjoiWFF0WTVEdHB0NUY0T1BJb24xdnEzMG05MWQxWk9aRmFLc2ZKS25FYjBpRXVlQm1nRXpoR0VBRDE" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "kmbflYHJf9F3qp1nUGVPonvb4X6ZSzhuMCMlaHEC" "uc_cart_id" => "6f56825e1f8ec2a4e634571f22e84df9" "_previous" => array:1 [ "url" => "http://alpha.eurekaselect.com/chapter/2398" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-28 20:56:10GET/chapter/2398112193