You are consulted regarding a 50-year old male with Laennec’s cirrhosis, portal hypertension and hypersplenism. He has no history of gastrointestinal bleeding. You would recommend which of the following?

d. Observation

Patients with hypersplenism from portal hypertension usually present with thrombocytopenia as the primary manifestation. The role of splenectomy in such patients is controversial. Although splenectomy may transiently increase the number of platelets in the peripheral circulation, it generally does not improve survival. At the time of surgery, these patients have considerable risk for massive bleeding and subsequent complications related to hepatic dysfunction. These latter complications include ascites, coagulopathy, and wound complications. The severity of the underlying liver disease is the determining factor for these patients. Some believe that splenectomy is contraindicated in patients with portal hypertension. Indeed, the perioperative risks are considerably greater than normal. This should be considered as a last option, and even then with the realization that the operative and preoperative morbidity and mortality are high. In the absence of gastrointestinal bleeding, this particular patient has no indication for either sclerotherapy or portosystemic shunting.