Minilaparoscopy-Guided Spleen Biopsy in Systemic Disease with Splenomegaly of Unknown Origin

With the advent of a minimally invasive laparoscopy technique, the advantages of diagnostic laparoscopy are being rediscovered. We report here on four patients with systemic disease of unknown origin and splenomegaly, in whom minilaparoscopy-guided splenic biopsy yielded a definitive diagnosis. Four patients with unclear systemic disease were studied using diagnostic minilaparoscopy and guided spleen biopsy, after failure of diagnostic work-up. Minilaparoscopic spleen biopsy revealed the diagnosis of a B-cell non-Hodgkin's lymphoma in two cases. In one patient, who had a history of Still's disease, the spleen biopsy showed granulocytic infiltration in the spleen typical of an acute episode of Still's disease. One patient with a known immunodeficiency syndrome (stage C III) showed multiple hypodense lesions in the spleen. Biopsy allowed a diagnosis of mycobacterial infection, with identification of Mycobacterium tuberculosis. No major complications occurred in any of the four cases; post-biopsy bleeding was observed in three of the four, but was easily managed by argon plasma coagulation or application of fibrin glue, or both. We recommend the use of spleen biopsy as a diagnostic tool in splenopathy of unknown origin if previous diagnostic methods have failed to yield a definitive diagnosis.

References

• 1 Meister H, Trux F. Erfahrungen mit der langen Menghini-Nadel bei der gezielten Leber- und Milzpunktion.  Dtsch Gesundheitswes. 1973;  28 6-8
• 2 Castellani R, Bonadonna G, Spinelli P. et al . Sequential pathologic staging of untreated non-Hodgkin's lymphomas by laparoscopy and laparotomy combined with bone marrow biopsy.  Cancer. 1977;  40 2322-2328
• 3 Helmreich-Becker I, Meyer zum Büschenfelde K H, Lohse A W. Safety and feasibility of a new minimally invasive diagnostic laparoscopy technique.  Endoscopy. 1998;  30 756-762
• 4 Thiele H, Berg P L, Frick B, Kalk J F. Fibrinkleberinjektion. Eine neue Methode zur Blutstillung nach laparoskopischer Leberbiopsie.  Dtsch Med Wochenschr. 1989;  114 1196-1198
• 5 Poralla T, Hütteroth T, Mayet W. et al . Peritonitis and massive granulocytic infiltration of the spleen in adult Still's disease.  Z Rheumatol. 1988;  47 363-365
• 6 Dagnini G, Caldironi M W, Marin G, Patella M. Laparoscopic splenic biopsy.  Endoscopy. 1984;  16 55-58
• 7 Spinelli P, Beretta G, Bajetta E. et al . Laparoscopy and laparotomy combined with bone marrow biopsy in staging Hodgkin's disease.  Br Med J. 1975;  6 554-556
• 8 Denzer U, Helmreich-Becker I, Mergener K. et al . Safety and value of minilaparoscopically guided liver biopsy in high risk patients [abstract].  Hepatology. 1999;  30 166A