Objective: To investigate the feasibility, safety, success rate of diagnosis and possible risk factors of splenectomy for fever of unknown origin (FUO) with splenomegaly.
Methods: The clinical data of 54 patients of FUO with splenomegaly who underwent splenectomy in Peking Union Medical College Hospital in the past 20 years were reviewed retrospectively. The diagnosis was not clear even after an extensive clinical evaluation before surgery. The pathologic findings, morbidity, mortality and possible risk factors were analyzed.
Results: Pathological diagnosis was made in 39 of the 54 patients (72.2%), including 29 cases of non-Hodgkin's lymphoma (NHL), 4 cases of spleen tuberculosis, 3 cases of Hodgkin's lymphoma, 1 case of Castleman's disease, and 2 cases of hemophagocytic syndrome. Among the 15 cases for whom pathological examination failed to make an confirmed diagnosis were diagnosed as with NHL in 4 cases, Still's diseases in 4 cases, hypersplenism in 2 cases, and lymphoproliferative disease in 2 cases during the follow-up. Operation complications occurred in 25.9% of the patients and 16.7% (9/54) of the patients died within one month after surgery. The mortality of the patients with dropsy of serous cavity was 46.2%, significantly higher than that of the patients without dropsy of serous cavity (7.5%). The mortality of the patients with a spleen heavier than 1500 g was 50.0%, significantly higher than that of the patients with a spleen lighter than 1500 g (11.8%). Complication of dropsy of serous cavity and splenomegaly were relatively independent death influencing factors (RR = 31.7 and 13.4 respectively, and P = 0.004 and 0.021 respectively). There was no significant differences in the mortality rates of the patients with or without jaundice, pancytopenia, elevated SGPT, elevated LDH or duration of the disease (all P > 0.1).
Conclusion: Splenectomy is an effective way for the diagnosis of FUO with splenomegaly. Patients with dropsy of serous cavity or a spleen heavier than 1500 g have higher mortality rates.