[HSF] Endocarditis with splenic infarct

[prasannasimha]

Incidentally why are people so concerned about splenic bed bleed ? The 
spleen is attached by the lienorenal and gastrosplenic "ligaments" that 
are the only structures that bear vascular structures and just need to 
be securely ligated. There is actually no "bed" in these spleens which 
are actually not very big. I (touch wood) have never had to go back in 
after splenectomy  and probably because I follow one cardinal rule  that 
was told by my general surgery professor - omental and splenic vessels 
have to be "transfixed" and ligated as a rule. Pop offs seem to be the 
major cause of disasters and is mitigated by transfixation.
Prasanna
Otto Thaning wrote:
> Nand!
> Am puzzled about the management of the patient who has a vegetation, positive blood culture and was treated on IV antibiotics and discharged from hospital within  the 2 week period after diagnosis. It is thus assumed the antibiotic treatment was shorter than ideal.
>
> The vegetation needs to be removed and I would recommend a 6 week course of appropriate antibiotic in hospital - a time that would allow you to monitor the splenic infarct. The danger there is the possible development of a splenic abscess.
>
> Otto Thaning
> Cape Town
>
> ----- Original Message ----- 
> From: "nand kejriwal" <nkkejriwal at gmail.com>
> To: <OpenHeart-L at lists.hsforum.com>
> Sent: Thursday, May 31, 2007 10:30 AM
> Subject: Re: [HSF] Endocarditis with splenic infarct
>
>
>   
>> Dear members
>>
>> 47 year man, admitted 2 weeks back with mitral valve endocarditis with
>> vegetation. Blood culture - Enterococcus faecalis. Put on Gentamycin and
>> Amoxycillin and discahrged. Readmitted 3 days ago with severe abdominal
>> pain.
>> CT - acute splenic infarct. No evidence of abscess formation. at this stage.
>>
>> Repeat TOE - vegetation still the same size.
>> Referred to me today. I am planning to operate tomorrow.
>>
>> Opinion of the forum regarding splenic infarct. My plan is to leave the
>> spleen alone and follow it up in the postop period. What are the chances of
>> bleeding into the infarct during heparinisation?  Would anyone recommend
>> concomitant splenectomy?
>>
>> Thanks
>>
>> nand
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