Contraindications to splenectomy in primary total extrahepatic portal hypertension

: The authors studied changes of hepatic circulation, hepatoportal hemodynamics, and homeostasis of peripheral and portal venous blood in response to removal of the spleen in primary total extrahepatic portal hypertension. The findings of rheohepatography, isotope hepatography, and ultrasonic flow measurement provided proof that splenectomy does not lead to intensification of the flow of arterial blood to the liver. Study of the portal pressure level did not demonstrate any significant hypotensive effect of splenectomy. Considerable changes occur after removal of the spleen, which creates real preconditions for the development of portal system thrombosis. All the above-said provides the basis for reducing considerably the range of indications for splenectomy and recommending it only in cases with marked clinical manifestations of hypersplenism hemolysis and increased tendency to bleeding.