Partial splenectomy in the treatment of splenic lesions and disorders in infants and children

ABSTRACT

This study was carried out on 11 infants and children, ranging in age between 26 days and 8 years, with localized benign splenic lesion or splenic disorder indicated for splenectomy. They were one case of wandering spleen, 3 cases of traumatic rupture of the spleen, four cases of thalassemia, one case of Gaucher's disease and one case of splenic cyst. They were treated by partial splenectomy. Lower polar splenectomy was performed in 10 cases while upper polar splenectomy was performed in one case of splenic cyst. All patients passed a smooth post-operative course with no bleeding or life threatening infection. Complications occurred in only 3 cases, one case of traumatic rupture of the spleen suffered in the early post-operative period from atelectasis and left pleural effusion and was treated conservatively while two cases of thalassemia suffered from intra-abdominal collection. In the later two cases, the dexon mesh used to wrap the remaining part of the spleen was accused to invite infection. The platelet count was significantly higher in the early post-operative period [P< 0.001]. Three months later, the platelet count was comparable with preoperative value [P> 0.05]. There was no increase in the number of pitted cells, Howel-Jolly bodies or Heinz bodies in the early or late post-operative period. The pre-operative serum IgM and IgG levels did not significantly differ from their levels in the early and late postoperative periods [P> 0.05]. Tha-lassemic children showed post-operative decrease in transfusion requirements and increased hemoglobin levels. Thus the immunological and hematological functions of the spleen are preserved after partial splenectomy and hence partial splenectomy is considered safe and better alternative to total splenectomy in the treatment of splenic disorders and benign lesions to avoid life threatening infections