Partial splenectomy for massive malarial splenomegaly: A unique case from an Australian regional centre

TL;DR

A rare case of partial splenectomy is reported to manage severe complications from malaria-related spleen enlargement in a patient from Papua New Guinea.

Contribution

This is the first reported case of partial splenectomy for massive malarial splenomegaly in the literature.

Findings

Partial splenectomy was performed for hypersplenism and complications from chronic malarial splenomegaly.

Multidisciplinary care was essential for managing complex preoperative and postoperative challenges.

The case highlights the rare but serious sequelae of Plasmodium falciparum malaria in non-endemic regions.

Abstract

This report describes a rare and remarkable case of partial splenectomy (PS) performed to manage the sequelae of massive malarial splenomegaly. It is likely the first reported case to date.

A 40-year-old female from Papua New Guinea presented shocked to a remote hospital in the Torres Strait Islands. She had a history of hyperreactive malarial splenomegaly syndrome (HMSS) during childhood. After urgent transfer and stabilisation in a regional centre, the patient underwent a PS.

Indications for surgery included hypersplenism, acute on chronic splenic infarction, portal vein thrombosis with portal hypertension and varices, and recurrent gastrointestinal bleeding. The decision to operate was complex, and perioperative optimisation required a multidisciplinary team.

This report adds new and valuable information to the current literature on the indications for PS. Moreover, it reminds clinicians about massive splenomegaly from P. falciparum malaria, associated sequelae, and the diagnostic and therapeutic challenges which are seldom encountered in Australia today.

•This report describes a unique case of partial splenectomy (PS) performed to manage the sequelae of massive malarial splenomegaly in a female from Papua New Guinea.•Formerly known as tropical splenomegaly syndrome (TSS), hyperreactive malarial splenomegaly syndrome (HMSS) is defined as massive splenic enlargement caused by an abnormal immune response, namely chronic antigenic stimulation to malarial parasites.•Currently, there are no evidence-based decision-making guidelines when considering PS for hypersplenism and previous HMSS.•Each individual case should be carefully selected and the decision for PS made in conjunction with a multidisciplinary team of infectious disease specialists, haematologists, gastroenterologists, and expert surgeons.

This report describes a unique case of partial splenectomy (PS) performed to manage the sequelae of massive malarial splenomegaly in a female from Papua New Guinea.

Formerly known as tropical splenomegaly syndrome (TSS), hyperreactive malarial splenomegaly syndrome (HMSS) is defined as massive splenic enlargement caused by an abnormal immune response, namely chronic antigenic stimulation to malarial parasites.

Currently, there are no evidence-based decision-making guidelines when considering PS for hypersplenism and previous HMSS.

Each individual case should be carefully selected and the decision for PS made in conjunction with a multidisciplinary team of infectious disease specialists, haematologists, gastroenterologists, and expert surgeons.

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