Splenic surgery in childhood - Surgical anatomy and techniques permitting tissue preservation

Abstract

In recent years efforts have been made to preserve the spleen after childhood injuries because of the increased risk of lethal sepsis following childhood splenectomy. The recent literature reveals that overwhelming postsplenectomy infection (OPSI) occurs with an incidence of 3.2% among splenectomized children, with a mortality of 45%. The incidence of OPSI is highest between birth and 2 years; children whose splenectomy was due to trauma had an incidence of 1.5%. OPSI after splenectomy for other diseases results in a higher incidence (5.6%). The case mortality rates are 17.6% and 55.6%, respectively. Splenic rupture constitutes an indication for total splenectomy, particularly when the rapture involves the splenic hilum (stage IV rupture, Barret et al. [1]). We performed anatomic studies of the splenic arterial supply, which showed that an identifiable superior splenic artery served the upper splenic pole in 60% of cases, offering the possibility that the upper pole might be salvaged even in cases of serious rupture. We report a series of 23 children treated for splenic injury in the last 5 years. Using fibrin-glueing techniques in stage I and II ruptures and segmental or subtotal resection in Stage III and IV ruptures, we successfully preserved functioning splenic tissue in every patient, even in cases of complete rupture of the main splenic artery. Functional preservation was documented by splenic scintigraphy and screening for hematologic signs of hyposplenism. Spleen ultrasonography was also performed as an additional follow-up examination. We observed no cases of OPSI in the above-mentioned series. © 1989 Springer-Verlag.