c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Massive Splenomegaly: 28

A D V E R T I S E M E N T

   
 

The ligated short gastric vessels along the greater curve of the stomach are shown. There is invariably a gastric ileus following splenectomy, especially with the dissection necessary for a massive spleen such as this. Therefore, a nasogastric tube is left in place. Gastric dilatation poses the risk of both aspiration and disruption of ties on the short gastric vessels.      

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Massive Splenomegaly: 29

A D V E R T I S E M E N T

   
 

The splenic bed was carefully checked for hemostasis. No drain was left. The controversy of earlier times about leaving a drain after splenectomy centered on the risk of retrograde infection up an open drain vs. the benefit of draining blood oozing from the raw surfaces, which is a good bacterial culture medium. In the present era of perioperative antibiotics and closed suction drains, a drain might be left only in the face of a severe coagulopathy and poorly-controlled oozing.     

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Massive Splenomegaly: 30

A D V E R T I S E M E N T

   
 

       

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This page was last modified on 3/14/2000.