Dr Rajesh Kol

🩺 Challenging Case: Massive Splenectomy in Thalassemia Major

A 22-year-old male with thalassemia major presented with progressive abdominal distension, transfusion-related hypersplenism, and discomfort due to a massively enlarged spleen extending well below the iliac crest.

📋 Clinical Considerations
• Long-standing transfusion dependence with hypersplenism.
• Risks: massive blood loss, adhesions, vascular anomalies.
• Goal: improved transfusion requirement, better quality of life.

🔪 Surgical Findings
• The spleen was enlarged to >25 cm, occupying the entire left abdomen and crossing midline.
• Dense perisplenic adhesions with multiple collateral vessels were encountered.
• Careful stepwise devascularization was performed, followed by controlled mobilization and successful splenectomy.

🧾 Outcome
• The patient tolerated the procedure well.
• Post-op: stable hemoglobin, reduced transfusion requirement, and symptomatic relief.

💬 Reflections
“Operating on a spleen larger than life is not just a surgery—it’s a balance between precision and resilience.”
“In thalassemia major, the spleen becomes both a protector and a burden. Surgery transforms that paradox into hope.”

✅ Key Learning Points
• Pre-op optimization (vaccination, blood preparation) is crucial.
• Massive splenectomy requires meticulous dissection and teamwork.
• Splenectomy can significantly improve transfusion dynamics in selected thalassemia patients.

Such cases remind us of the importance of surgical judgment, preparedness, and multidisciplinary care in managing complex hematological disorders.

# MP53 Sidhi MP

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Would you like me to also prepare a shorter, more public-friendly version (focusing on patient impact and hope), alongside this academic-style version for surgeons?

Bladder stone of 7.5*5 *3.5 cm size in a patient having history of Neobladder construction surgery 5 years back.. 🤞