Emergency or urgent splenectomy in children for non-traumatic reasons
Emergency splenectomy is rarely performed since a widespread consensus exists towards conservative management of splenic injury. However, in selected conditions, mainly hematological, there is a role for emergency or urgent splenectomy. This study aims to retrospectively review these cases and discuss outcome in relation to the pre-existing splenic pathologies. Between 2000 and 2015, 12 patients, five girls, and seven boys, with a median age of six years (3 months–13.11 years), underwent emergency or urgent splenectomy for non-traumatic conditions. All patients had major associated disorders; mainly hematological (11 cases) including hemolytic anemia with pancytopenia (1), sickle cell anemia (1), AML (1), ALL (2), CML (1), T cell lymphoma (1), Burkitt lymphoma (1), and ITP (3). One patient had a microvillous inclusion disease. Indications for splenectomy included diffuse resistant splenic abscesses (4), intracranial hemorrhage (4) or hypersplenism (3) with refractory thrombocytopenia, and spontaneous splenic rapture (1). Nine patients improved following surgery but three died, owing to massive intracranial hemorrhage (1) and severe respiratory failure (2) despite aggressive management.
What is known
• Conservative treatment is advised for splenic injury.
• Many hematological disorders are responsible of splenic pathology.
What is new
• Emergency splenectomy in children for reasons other than trauma is a treatment of last resort that should be performed in a multidisciplinary context.
• The outcome of emergency splenectomy in children for reasons other than trauma depends on the underlying medical condition.
KeywordsEmergency splenectomy Non-traumatic Children
Acute lymphoblastic leukemia
Acute myeloid leukemia
Chronic myeloid leukemia
- CT scan
Computerized tomography scan
Immune thrombocytopenic purpura
Study conception and design: Dr. I. Samuk, Dr. A. Baazov, Pr. E. Freud
Data acquisition: Dr. E. Seguier-Lipszyc, Dr. I. Samuk
Analysis and data interpretation: Dr. E. Seguier-Lipszyc, Pr. H. Tamary
Drafting of the manuscript: Dr. E. Seguier-Lipszyc, Dr. I. Samuk
Critical revision: Dr. R. Steinberg, Dr. E. Nahum, Pr. H. Tamary, Pr. E. Freud
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any study with human participants or animals performed by any of the authors.