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

Abstract

Introduction and importance: This report describes a rare and remarkable case of partial splenectomy (PS) per formed to manage the sequelae of massive malarial splenomegaly. It is likely the first reported case to date. Case presentation: 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. Clinical discussion: 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. Conclusion: 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.