Partial splenic embolization in children with hypersplenism.

Abstract

Partial splenic embolization (PSE) was successfully accomplished in 10 of 11 children, aged 2-9, who had portal hypertension or variceal bleeding. Nine of the 11 children had undergone portoenterostomy (Kasai operation) for biliary atresia, and two had portal vein thrombosis. After embolization these children had a longer period of fever (mean = 23.7 days) and elevated white blood cell (WBC) count (above 10,000, mean = 13.6 days) than adults who have undergone the same procedure. The leukopenia and thrombocytopenia of hypersplenism were corrected by PSE in seven of eight children, and the condition of the eighth child improved. Among ten patients who had experienced episodes of variceal hemorrhage, the frequency of bleeding episodes was reduced from an average of 2.87 per year before PSE to 0.67 per year after PSE. There were no splenic abscesses and no other significant complications of the treatment. Ultrasound (US) evaluation after embolization demonstrated hypoechogenicity of the infarcted areas and tiny, linear echoes scattered throughout the spleen typical of postinfarction intravascular gas. All nine children who underwent follow-up Tc-99m sulfur colloid scanning showed evidence of splenic regeneration, though none has had recurrence of clinical symptoms. Splenic regeneration following PSE may occur more frequently in children than in adults.

Partial splenic embolization in a child with hereditary spherocytosis

“…There were no modifications in the white cells. The clinical course in our patient was similar to that described by others [3,6], with moderate fever for 3 days, mild abdominal pain and vomiting (known as the postembolization syndrome) and alleviated by symptomatic treatment [2]. We did not observe any other complications (e.g.…”

“…The procedure was initially associated with significant morbidity and mortality, but subsequent series report substantially improved results [6]. We performed the embolization technique described by Spigos [1,3,6,8] because it has a very low risk of complications, although Israel et al [5] recently reported a lower rate of complications using polyvinyl alcohol.The increase in haemoglobin values found in our patient has been observed in patients affected by other diseases who have required PSE [5]. The thrombocytosis observed in our patient during the first 15 days after PSE that returned to normal values over 3 months, has been previously reported [3,5].…”

“…The procedure was initially associated with significant morbidity and mortality, but subsequent series report substantially improved results [6]. We performed the embolization technique described by Spigos [1,3,6,8] because it has a very low risk of complications, although Israel et al [5] recently reported a lower rate of complications using polyvinyl alcohol.…”

Evaluation of Three Methods of Treatment of Hypersplenism

“…Kumpe et al [17] recorded one patient with mild increase in amylase, although he did not have clinical pancreatitis.…”

Splenic Artery Embolization as an Adjunctive Procedure for Portal Hypertension

“…6 Following the adoption of partial embolization and antibiotic coverage, multiple case reports and nonrandomized series reported a reduction in both morbidity and mortality rates compared with complete splenic embolization. [7][8][9][10][11][12][13][14][15] Current indications for splenic embolization include treatment of portal hypertension and control of splenic hemorrhage from trauma or prior to surgical resection. It is also used to improve platelet counts in patients with idiopathic thrombocytopenic purpura, to treat the sequelae of hypersplenism, and to manage splenic steal syndrome (nonocclusive hepatic artery hypoperfusion syndrome [NOHAH]) in liver transplant recipients.…”