Aneurisma gigante de la arteria esplénica: reporte de un caso / Giant splenic artery aneurysm: case report

Resumen Objetivo: Reportar el caso de un aneurisma gigante de la arteria esplénica de 9,5 cm de diámetro, en una mujer de 75 años de edad, que consultó por síndrome vertiginoso, con hallazgo incidental al examen físico de masa abdominal pulsátil, confirmado mediante angiotomografía de abdomen y pelvis. Materiales y Método: Registro clínico de una paciente sometida a reparación quirúrgica abierta de una aneurisma gigante de la arteria esplénica. Resultados: Mediante laparotomía, abordaje anterior, se efectúa la ligadura del aneurisma con resección parcial del saco aneurismático más esplenectomía, evolucionando sin complicación a 12 meses de seguimiento. Discusión: Se define como aneurisma de la arteria esplénica a toda dilatación mayor a 1 cm de diámetro, presenta indicación quirúrgica cuando mide más de 2 cm y se denomina gigante a partir de los 5 cm. Conclusión: Los aneurismas de la arteria esplénica son una condición infrecuente, habitualmente asintomática, pero potencialmente mortal especialmente en embarazadas; en la literatura solo existen 78 casos reportados de aneurismas gigantes de la arteria esplénica, se recomienda la resolución quirúrgica expedita.

Aim: To report the case of a giant splenic artery aneurysm of 9.5 cm diameter, in a 75 years old woman, who consulted for vertiginous syndrome, with incidental finding to the physical examination of pulsatile abdominal mass, confirmed by angiotomography of abdomen and pelvis. Materials and Method: Clinical record of a patient undergoing open surgical repair of a giant splenic aneurysm. Results: By laparotomy, anterior approach, the ligation of the aneurysm is performed with partial resection of the aneurysm sac plus splenectomy, evolving without complication at 12 months of follow-up. Discussion: The splenic artery aneurysm, is defined at any dilatation greater than 1 cm in diameter, it is surgically indicated when they measure more than 2 cm and called giant from 5 cm. Conclusion: Splenic artery aneurysm is a uncommon condition, usually asymptomatic, but potentially fatal especially in pregnant women, in the literature there are only 78 reported cases of giant splenic artery aneurysms, expedited surgical resolution is recommended.

Endovascular treatment of acute gastrointestinal bleeding from a large splenic artery pseudoaneurysm: case report and literature review / Tratamento endovascular da hemorragia digestiva aguda por volumoso pseudoaneurisma esplênico: relato de caso e revisão da literatura

O pseudoaneurisma da artéria esplênica é uma entidade rara, com pouco mais de 150 casos descritos na literatura. A pancreatite é a etiologia mais comum, seguida do trauma. Em contraposição ao aneurisma verdadeiro, esse pseudoaneurisma é frequentemente sintomático, com risco de ruptura de 47% e mortalidade de 90%, quando não tratado. Descrevemos o caso de uma paciente de 48 anos que apresentou hemorragia gastrointestinal associada a pancreatite crônica agudizada. Durante investigação, a endoscopia evidenciou sinais de sangramento recente, e a angiorressonância de abdome observou volumoso pseudoaneurisma da artéria esplênica. Foi submetida a tratamento endovascular com embolização com micromolas, não apresentando novos episódios de sangramento. Atualmente, o tratamento endovascular é efetivo com baixa morbimortalidade e taxas de sucesso de 79-100%, sendo uma técnica viável para pacientes com processo inflamatório abdominal em franca atividade. Realizamos uma revisão das técnicas endovasculares e agentes embolizantes usados para o tratamento dessa patologia

Pseudoaneurysm of the splenic artery is a rare entity, with little more than 150 cases described in the literature. Pancreatitis is the most common etiology, followed by trauma. In contrast with true aneurysms, pseudoaneurysms are frequently symptomatic, with a 47% risk of rupture and 90% mortality if left untreated. We describe the case of a 48-year-old female patient who suffered a gastrointestinal hemorrhage associated with acute-on-chronic pancreatitis. During workup, endoscopy revealed signs of recent bleeding and magnetic resonance angiography of the abdomen showed a large pseudoaneurysm of the splenic artery. The patient underwent endovascular treatment with microcoil embolization and no further bleeding episodes occurred. Endovascular treatment is now an effective option with low morbidity and mortality and success rates in the range of 79-100%, making it a viable technique for patients with active abdominal inflammation. We conducted a review of endovascular techniques and embolization agents used to treat this pathology

Variantes anatómicas de la arteria esplénica / Anatomic variants of the splenic artery

Introducción: la arteria esplénica es uno de los tres ramos del tronco celiaco que irriga el bazo y emite ramos al estómago y al páncreas. Objetivo: determinar las características morfológicas de la arteria esplénica. Materiales y métodos: se realizó un estudio cuantitativo, longitudinal, prospectivo, observacional y descriptivo, en 26 bloques, provenientes de cadáveres sin cirugías abdominales, ni enfermedades hematológicas, en el Hospital Provincial Universitario "Celia Sánchez Manduley", de Manzanillo, provincia Granma. Los bloques fueron lavados, fijados y disecados por el método macroscópico directo. Resultados: La arteria esplénica se originó, mayormente en el tronco celiaco (88,46 %), su trayecto fue tortuoso en el 84,62 % de los bloques relacionándose por delante de la vena esplénica (80,77 %). Los ramos colaterales fueron más frecuentes en el segmento pancrático (54,96%). Las arterias gástricas cortas fueron los ramos colaterales mayormente emitidos (100 %). La longitud media de la arteria esplénica fue de 14,7 cm y su diámetro medio es de 0,86 cm. El número de arterias terminales tuvo una media de 6,04, mientras que las arterias gástricas cortas se emitieron en una media de 4,76. Conclusiones: la arteria esplénica presenta un patrón de variabilidad anatómica bajo en cuanto a su origen y trayecto, pero sus relaciones, forma de terminación, y ramos colaterales presentan grandes variantes a la norma anatómica (AU).

Introduction: the splenic artery is one of the three of the celiac trunk that irrigates spleen and emits branches to the stomach and the pancreas. Objective: to determine the morphologic characteristics of the splenic artery. Materials and methods: a descriptive, observational, prospective, longitudinal and quantitative study was carried out in 26 tissue samples without abdominal surgeries nor hematologic diseases in the Teaching Provincial Hospital "Celia Sánchez Manduley" of Manzanillo, Granma. The samples were washed, fixed and dissected using the direct macroscopic method. Results: the splenic artery originated, mostly, in the celiac trunk (88.46 %), its itinerary was tortuous in 84.62 % of the samples, linking before the splenic vein (80.77 %). Collateral branches were more frequent in the pancreatic segment (54.96 %). Short gastric arteries were the mostly emitted collateral branches (100 %). The average longitude of the splenic artery was 14.7 cm and its average diameter 0.86 cm. The number of terminal arteries showed an average of 6.04 while the short gastric arteries were emitted in an average of 4.76. Conclusions: the splenic artery has a low anatomic variability pattern according to its origin and itinerary, but its relations, ending form and collateral branches show big variants from the anatomic norm (AU).

The therapeutic challenge of giant splenic artery aneurysm: a case repport / O desafio terapêutico do aneurisma gigante da artéria esplênica: um relato de caso

ABSTRACT Giant splenic artery aneurysm is a rare condition that represents an eminent life threatening for the patient, requiring, therefore, urgent surgical correction. A 61-year-old woman, former smoker, hypertensive, hypercholesterolemic and multipara sought our service because of a large tumor in the mesogastrium, which was an abdominal ultrasound finding. Despite the size of the tumor, the patient was asymptomatic. The angiotomography and the magnetic resonance image of the abdomen were suggestive of giant splenic artery aneurysm with more than 10cm in diameter that was confirmed by an angiography. She underwent surgery, open splenectomy, and partial aneurysmectomy. The approach of the celiac artery, which was ligated, was only possible with medialvisceral rotation because there was no possibility to view it through the anterior access. The histopathological test of aneurysmatic wall revealed atheroma plaques in the intima. The patient progressed without complications and she was discharged cured. In general, giant splenic artery aneurysms are symptomatic, however, as in the case we report, it may be asymptomatic and found in abdominal imaging exam. Although less invasive Interventional methods exist, such as laparoscopy and endovascular techniques, they were considered inappropriate in this case. Conventional open surgery should be the therapy of choice for a giant splenic artery aneurysm.

RESUMO O aneurisma gigante da artéria esplênica constitui condição rara, que representa risco de vida iminente para o paciente, necessitando, consequentemente, de correção cirúrgica urgente. Mulher de 61 anos, ex-fumante, hipertensa, com hipercolesterolêmica e multípara nos procurou por apresentar grande tumor no mesogástrio, achado de ultrassonografia abdominal. Apesar das dimensões do tumor, era assintomática. Angiotomografia e ressonância magnética de abdômen sugeriam tratar-se de aneurisma gigante de artéria esplênica com mais de 10cm de diâmetro, confirmado por angiografia. Foi submetida a tratamento cirúrgico aberto, tendo sido realizadas esplenectomia e aneurismectomia parcial. A abordagem do tronco celíaco, que foi ligado, só foi possível com rotação visceral medial, pois não havia possibilidade de visualizá-lo pela via anterior. O exame anatomopatológico da parede do saco aneurismático revelou placas de ateroma na íntima. A paciente evoluiu sem intercorrências e teve alta hospitalar curada. Aneurismas da artéria esplênica de dimensões avantajadas, em geral, são sintomáticos, porém, como no caso em questão, podem ser assintomáticos e descobertos em exame de imagem do abdômen. Apesar de existirem métodos intervencionistas menos invasivos, como laparoscopia e técnicas endovasculares, eles não foram considerados adequados neste caso. Diante de um aneurisma gigante de artéria esplênica, a conduta terapêutica de eleição é a cirurgia convencional aberta.

Spontaneous Splenic Rupture in a Vivax Malaria Case Treated with Transcatheter Coil Embolization of the Splenic Artery

An enlarged spleen is considered one of the most common signs of malaria, and splenic rupture rarely occurs as an important life-threatening complication. Splenectomy has been recommended as the treatment of choice for hemodynamically unstable patients. However, a very limited number of splenic rupture patients have been treated with transcatheter coil embolization. Here we report a 38-year-old Korean vivax malaria patient with ruptured spleen who was treated successfully by embolization of the splenic artery. The present study showed that angiographic embolization of the splenic artery may be an appropriate option to avoid perioperative harmful effects of splenectomy in malaria patients.

Aneurisma esplénico / Splenic aneurysm

Introduction: The splenic aneurysm (AAE) is a rare disease that occurs mainly in women, being mostly asymptomatic until rupture. Clinical case: We report a case of a woman aged 65, previously healthy, who complains of pain in the left upper quadrant, two-month history, performing a CT of the abdomen showing a 4.7 cm AAE without signs of rupture. Aneurysm resection was performed with splenic preservation with no signs of complication...

Introducción: El aneurisma esplénico (AAE) es una enfermedad poco frecuente, que ocurre principalmente en mujeres, siendo en su mayoría asintomático, hasta su ruptura. Caso clínico: Presentamos el caso de una mujer de 65 años, previamente sana, que consulta por dolor en hipocondrio izquierdo, de dos meses de evolución, realizándose una tomografía de abdomen, que muestra un AAE de 4,7 cm sin signos de ruptura. Se realiza resección de aneurisma con preservación esplénica, sin signos de complicación en el postoperatorio. Aunque presenta infartos esplénicos en el control se mantiene asintomática...

Double catheter technique: a new approach for treatment of anatomically challenging splenic artery aneurysm: a case report

Splenic artery aneurysms are the most common visceral aneurysm. They are usually asymptomatic, but may present rarely as abdominal pain, or with symptoms and signs of acute rupture. This is a case report of a 42 years old female patient who presented with mild abdominal pain and was found to have a splenic artery aneurysm with a challenging anatomy of the prominent splenic artery. The patient refused the surgical option of treatment, and was treated by endovascular embolization, using a double catheter technique.

Blood changes after splenectomy in portal hypertension. The "Amna model"

Splenectomy is a frequently performed operation for patients with portal hypertension and hypersplenism in areas endemic for schistosomiasis. Reactive thrombocytosis [RT] has been described following splenectomy. Nevertheless, data are lacking on the long term changes of platelet count and other blood cells and indices after splenectomy in such patients. To determine the hematological changes following splenectomy in portal hypertension due to schistosomiasis. This is a prospective, observational, case study in which we did a series of full blood counts before and after splenectomy on two patients. The periods of study were 12 days and 5 months, respectively. Platelets [RT>500x10[9]] occurred after the 7[th] post-splenectomy day in both patients. In the longer study, RT continued from day 8 to week10. Extreme thrombocytosis [> 1000x 10[9]] occurred from day 11 to day 21 postoperatively. The count was back to normal by week 17. Reactive leukocytosis occurred immediately after ligation of the splenic artery, but returned to normal levels during the 2[nd] postoperative week. Erythrocytes, however, showed changes different from both platelets and leukocytes. There was "persistent anaemia" for about one month postoperatively. This study provides data that were lacking on the long term haematological effects of splenectomy in Sudanese patients with portal hypertension. Knowing these changes can have important implications on the management and follow up of such patients, and provide evidence needed for discussing guidelines of treatment. RT and leukocytosis occur after splenectomy whereas anaemia persists. RT can reach extreme levels and it is wise to monitor the platelets after the discharge of patients from the hospital. It may also be wise to consider the use of antiplatelet drugs postoperatively till the count normalizes. The persistent anaemia, however, seems to correct itself without giving haematinics or blood transfusion.

Resección de aneurisma de arteria esplénica por vía laparoscópica conservando el bazo / Laparoscopic surgical excision of a splenic aneurism

Elective surgical repair is indicated for splenic aneurisms when they are wider than 20 mm, during pregnancy and when a progressive increase in diameter is documented. We report a 63 years old female with a history of hypertension, presenting with pain in the right upper quadrant. An abdominal CAT scan disclosed a hepatic cyst and an aneurism of the splenic artery of 20 mm diameter. A laparoscopic excision of the aneurism was carried out without performing a splenectomy. A CAT scan done one month later postoperative period detected a small lateral spleen infarction and a subcapsular collection of 2 cm diameter.

Los aneurismas esplénicos, a pesar de ser los aneurismas viscerales más frecuentes, son inhabituales. Su resolución quirúrgica electiva se considera cuando presentan un diámetro mayor a 2 centímetros, son sintomáticos, se presentan en pacientes embarazadas o se demuestra su crecimiento progresivo. Ello debido a que las variables mencionadas aumentan su riesgo de ruptura. El manejo endovascular mediante embolización de la arteria esplénica, o la cirugía abierta con aneurismectomía con esplenectomía u, ocasionalmente, sólo con reparación arterial, corresponden a los manejos electivos más aceptados. Se presenta un caso clínico de aneurisma de arteria esplénica, manejado electivamente con una técnica quirúrgica novedosa. Se trata de una paciente en quien, por vía laparoscópica, se realizó resección del aneurisma y se preservó el bazo. La presentación de este caso, con un abordaje menos invasivo y que permite evitar la esplenectomía, nos invita a replantear los manejos clásicos endovasculares o abiertos, que son más complejos y, habitualmente, requieren la esplenectomía.

Growth of the lower spleen pole remaining after subtotal splenectomy in rats

PURPOSE: To determine whether the lower pole of the spleen grows after subtotal splenectomy following ligature of major spleen blood vessels. METHODS: Thirty-nine Wistar rats (328.8 ± 27.8 g) submitted to subtotal splenectomy with preservation of the lower splenic pole were divided into two groups: group 1 (control, n=20), immediate removal of the lower pole; group 2 (n=19), removal of the pole on postoperative day 80. The length, width and thickness of the pole were measured. In the control group, mean percent pole weight was calculated immediately after surgery in a direct and indirect manner. In the first case, the weight of the lower pole was divided by overall spleen weight; in the second case, pole weight was divided by the ideal weight of the spleen obtained by linear regression analysis. The results of the two calculations were compared. Macro- and microscopic examinations of the pole were performed. RESULTS: In group 1, no significant difference in mean percent pole weight was observed between the direct and indirect method. In group 2, mean percent pole weight obtained by indirect calculation on day 80 was higher than in group 1 (p<0.001). In group 2, mean length, width and thickness of the pole remnant increased from the first to the 80th day (p<0.05). Histological analysis showed preserved tissue architecture and features compatible with cell hyperplasia in group 2. CONCLUSION: The lower pole splenic remnant presented statistically significant growth up to postoperative day 80 after subtotal splenectomy, even after ligature of the major spleen vessels. Light microscopy revealed changes compatible with cell hyperplasia.

OBJETIVO: Verificar se o pólo inferior do baço cresce após a esplenectomia subtotal mesmo com a ligadura dos vasos esplênicos principais. MÉTODOS: 39 ratos, Wistar, pesando 328,8g ± 27,79 foram submetidos à esplenectomia subtotal com preservação do pólo inferior e distribuídos em dois grupos de acordo com a época da retirada do referido pólo: 1- controle (n=20)-retirada imediata; 2(n=19); retirada no 80º dia de pós-operatório. Foram medidos o comprimento, largura e espessura do pólo inferior. No grupo controle, o percentual médio do pólo inferior foi calculado imediatamente após a cirurgia de forma direta e indireta, e no grupo 2 de forma indireta. No cálculo direto dividiu-se o peso do pólo inferior pelo peso global do baço. No cálculo indireto dividiu-se o peso do pólo inferior pelo peso ideal do baço obtido por análise de regressão linear. Foi realizada a comparação entre esses dois cálculos. Foi realizado o exame macro e microscópico do pólo inferior. RESULTADOS: Não houve diferença significante entre o cálculo direto e indireto do percentual médio do pólo inferior no grupo 1. No grupo 2 o percentual médio do pólo inferior, por cálculo indireto, no 80º dia foi maior que no grupo 1 (p <0,001). A média do comprimento, largura e espessura desse remanescente no grupo 2 aumentou do 1º para o 80º dia( p<0,05). A análise histológica mostrou no grupo 2 manutenção da arquitetura esplênica e sinais compatíveis com hiperplasia celular. CONCLUSÃO: O pólo inferior do baço remanescente da esplenectomia subtotal, mesmo com a ligadura dos vasos esplênicos principais, apresentou média de crescimento significante no 80º dia de pós-operatório e à microscopia óptica de luz houve sinais compatíveis com hiperplasia celular.

Aneurisma gigante de la arteria esplénica / Giant aneurism of the esplenic artery

Presentación de un caso clínico, con un paciente en tratamiento ambulatorio por padecer cáncer de próstata con buena evolución clínica. Los aneurismas de la arteria esplénica suelen ser un hallazgo ocasional, pero relacionados con un importante riesgo de ruptura, por lo que los médicos de guardia deben estar alertas ante su existencia

Management of visceral artery aneurysms

Objective: Visceral artery aneurysms, despite being uncommon, are important vascular diseases, since they frequently are life threatening, and often fatal emergencies. The purpose of this study is to review our experience with treatment of visceral artery aneurysms. Method: Between 1988 and June, 2004, 37 visceral artery aneurysms were treated in 35 patients (17 male and 18 female) with average age of 56 mais ou menos 14 years. The most common locations were the splenic artery (18), the hepatic artery (10) and the superior mesenteric artery (four), 22 patients were asymptomatic, 13 patients were symptomatic. Emergency surgery was performed on three patients, elective open surgery on 20 patients, and endovascular treatment onseven patients. Results: Perioperative mortality rate was 3,1 por cento in the surgical group. The perioperative mobidity rate was 5,7 por cento: one case of respiratory distress and one case of bilious fistula were...

Alternativas quirúrgicas a la esplenectomía postraumática, procedimientos de rescate esplénico en población pediátrica / Alternative procedures to splenectomy in pediatric population

Antecedentes: Hace cuatro décadas las normas del Departamento de Cirugía de nuestro Hospital, establecían esplenectomizar a los niños con bazos dañados, destacando que estas disposiciones eran reglas quirúrgicas con consenso mundial. Las graves complicaciones infecciosas, condujeron a desarrollar estrategias que permitieron realizar tratamientos quirúrgicos conservadores aun ante graves traumatismos. Objetivo: Conocer una serie de procedimientos alternativos a la esplenectomía, ya que la misma en pediatría conlleva un elevado riesgo de morbi-mortalidad por sepsis, sobre todo en menores de 5 años. Lugar de aplicación: Hospital de Niños Ricardo Gutierrez (HNRG) de Buenos Aires, Argentina. Diseño: Trabajo retrospectivo, observacional, no comparativo y cerrado. Población: Se trata de un grupo de 6 niños con lesiones esplénicas graves. Método: Fueron tratados mediante un protocolo normatizando en base a los criterios de atención inicial del curso ATLS del Colegio Americano de Cirujanos y el Comité de Trauma del HNRG. Para valorar el grado de lesión esplénica se utilizó el Organ Injury Scale OIS-(Spleen Injury Scale) y se categorizó la severidad de las lesiones utilizando el Abreviated Injury Scale 90. Resultados: Las cirugías realizadas (procedimientos operatorios alternativos a la esplenectomía), fueron las siguientes: 3 encestes con Vicryl Mesh, 2 ligaduras arteriales y 1 envoltura esplénica con parche de epiplón y bañado con adhesivo tisular. Todos los pacientes evolucionaron favorablemente. Conclusiones: En pediatría los traumatismos cerrados a nivel abdominal, en raras ocasiones requieren laparotomía, pero cuando esto sucede es recomendable que el cirujano maneje un amplio repertorio de técnicas quirúrgicas conservadoras y trabaje empeñado en no resecar el bazo, especialmente en niños menores de 5 años

Pseudoaneurysm and splenic infarction in chronic pancreatitis: a case report

Peripancreatic pseudoaneurysm and splenic infarction are rare but life-threatening complications of chronic pancreatitis. The incidence of pseudoaneurysm in patients who undergo angiography for pancreatitis is about 10%. Clinically, pseudoaneurysm is hard to discover until rupture occurs. The authors have recently experienced a case of intact pseudoaneurysm and splenic infarction in chronic alcoholic pancreatitis. A bolus enhanced CT scan and angiography were essential to confirm these complications of pancreatitis. We managed these complications successfully by distal pancreatectomy and splenectomy.

Aneurisma de artéria esplênica em pacientes com esquistossomose mansônica hépato-esplênica e hipertensäo portal: relato de três casos / Splenic artery aneurysm in patients with hepato-splenic schistosomiasis mansoni and portal hypertension: report of 3 cases

Säo apresentados três casos de aneurisma de artéria esplênica encontrados em 96 pacientes protadores de esquistossomose hepato-esplênica e hipertensäo portal. Säo discutidos etiologia, diagnóstico e tratamento desta rara afecçäo

Aneurismas esplácnicos / Splachnic aneurysms

Los aneurismas esplácnicos son una rara entidad. La forma complicada (en particular la rotura intra o retroperitoneal) constituye la presentación habitual. Se presentan 9 casos (3 de la arteria esplénica, 5 de la gastroduodenal y 1 de la hepática). Se considera acerca de la epidemiología, hallazgos clínicos, diagnóstico y tratamiento quirúrgico para cada grupo en particular

Hemorragia digestiva por várices esofagicas: tratamiento quirúrgico de urgencias por cirujanos generales / Bleeding esophageal varices: emergency surgical treatment by general surgeons

Se trataron 14 pacientes con hemorragia digestiva alta por várices esofágicas sangrantes entre 1979 y 1986. Nueve pacientes eran del sexo masculino (64,2%), la edad promedio fue de 52,8 años. El diagnóstico se estableció por endoscopia en 12 enfermos (85,7%); 10 (71,4%) pertenecían al grupo C de la clasificación de Cchcild. El tratamiento no quirúrgico consistió en la utilziación del balón de Sengstaken-Blakemore con control temporario de la hemorragia en la totalidad de los casos. Se indicó cirugia ante la recidiva del cuadro hemorrágico, colocandose un botón endoesofágico tipo Liard en todos los casos y en 5 (35,7%) se agregó la ligadura de la artéria esplénica. Se obtuvo la detención inmediata de la 2ª hemorragia en el 100% de los operados, con sobrevida del 50% en el grado C de la clasificación clínica de Child. Las complicaciones registradas fueron esplenomegalia (2 casos), recidiva de la hemorragia (2 casos) y disfagia (1 caso)

Splenic artery ligation and vasoligation in the management of bleeding oesophageal varices

The effects of splenic artery ligation combined with vasoligation of the short gastric, left gastric vessels and veins around the abdominal esophagus were studied in 20 patients with bleeding esophageal varices. Follow-up period varied between 18-24 months. The liver pathology was bilharzial fibrosis in 17 [85%], mixed in 2 [10%] and post-hepatic cirrhosis in one [5%]. The patients were classified according to the modified Child's Risk Grading into grade A [20%], B [60%] and C [20%]. The drop in portal pressure varied between 23 and 5 cm/H20 [mean 8.1 cm/H20]. Recurrent bleeding after 20 months occurred in one [5%]. Postoperative ascites developed in four [20%], but was easily controlled medically. All the patients showed improvement in the peripheral blood picture. Deterioration in liver function tests occurred in one patient. None of the patients developed splenic abscess or cysts. Endoscopic follow-up showed that the varices did not disappear, but progressed. There was no operative mortality. One patient [5%] died two months postoperatively from progressive liver failure. The preliminary results of this line of treatment are encouraging, but longer follow-up is still needed

[ treatment of hypersplenism in the child by ligation of the splenic artery]

Because of the danger of post-splenectomy infection and the limitations of prophylaxis, and since it is possible to reduce the splenic function while preserving the spleen, the treatment of various hematologic disorders by splenic artery ligation has been attempted in 11 children, among whom 3 under 5 years of age. 3 patients had thalassemia, 4 had hereditary spherocytosis and 4 others suffered from secondary hypersplenism. One patient died of overlooked splenic necrosis. The other patients are well, with an average follow-up of 19 months. The aim of this study is to find out whether the dearterialization produces the expected results and is well tolerated and whether the dearterialized spleen still preserves its ability to protect the host against infection. The satisfactory treatment of hereditary spherocytosis and secondary hypersplenism would indicate that splenic artery ligation offers an alternative to splenectomy, especially in children under 5 years