Natalia Kubicki, MD1, Stephen Kavic, MD1, Hugo Bonatti2. 1University of Maryland Medical Center Surgery, 2University of Maryland Community Medical Group Surgical Care
Background: Splenectomy together with colectomy is typically performed as a result of iatrogenic injury and not as an additional elective procedure. We report a first patient who underwent elective combined laparoscopic sigmoid resection and splenectomy for recurrent diverticulitis and splenic granulomatous disease.
Case Report: A 50-year-old African American female presented with recurrent episodes of diverticulitis. Her past medical history was significant for generalized fatigue, dyspnea, mediastinal and porta hepatis lymphadenopathy, and subcutaneous nodules but biopsy were unable to establish diagnosis. Prior to evaluation for laparoscopic sigmoid resection, the patient developed evidence of innumerable hypodense splenic lesions. Splenectomy was offered to the patient to be performed in addition to sigmoid resection. Five mm trocars were placed in the right upper quadrant, umbilicus and previous Pfannenstiel incision and a 10/12 mm trocar in the right lower quadrant. The severely inflamed sigmoid colon was mobilized and dissection followed first towards the rectum, which was stapled. Next, the descending colon was freed and the splenic flexure was completely mobilized. The short gastric vessels were divided and the retroperitoneal attachments of the spleen, which showed multiple granulomas, were cut. The splenic hilum was divided with an Echelon stapler. The Pfannenstiel incision was reopened and the spleen was removed in a retrieval bag and the colon was pulled out of the abdomen. The colorectal anastomosis was created with an EEA stapler. Splenic pathology demonstrated multiple noncaseating granulomas with appearance consistent with sarcoidosis. The patient tolerated the procedure without complications and had an uneventful post-operative course. She established care with a sarcoidosis specialist and was started on prednisone and methotrexate with improvement in her symptoms.
Conclusion: Our case highlights the value of elective laparoscopic splenectomy performed in addition to segmental colon resection as a safe procedure. Diagnosis of sarcoidosis was established and the patient did not require two surgeries.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80631
Program Number: P609
Presentation Session: Poster (Non CME)
Presentation Type: Poster
