Abstract
Because of long-standing hypersplenism and mechanical problemes resulting from massive splenomegaly, approximately 90% partial splenectomy was performed in a 16-year-old boy with Gaucher's disease. After resection of the massive spleen, a small remnatnt of the upper pole of the spleen remained, and this was vascularized by only the short gastric verssels. Two pieces of a thumb-sized accessory spleen were also saved. Bleeding from the cut surface was controlled with an argon laser coagulator and by placement of hemostatic materials. The cut edge was approximated with stitches using interrupted absorbable sutures. The sutured area was widely covered with omentum and the area was fixed to the gastric wall with several stitiches to prevent torsion. The postoperative liver-spleen scan confirmed an adequate blood flow to the residual splenic fragment and the accessory spleens. Accelerated skeletal deterioration after splenectomy has not been observed and the patient's quality of life has been considerably improved. When the upper pole of the spleen is retained, as in the present case, transection and hemostasis is thought to be technically easier to achieve than when resection is performed closer to the center of the spleen.
