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European Journal of Pediatrics

, Volume 178, Issue 9, pp 1363–1367 | Cite as

Emergency or urgent splenectomy in children for non-traumatic reasons

  • Inbal Samuk
  • Emmanuelle Seguier-LipszycEmail author
  • Artur Baazov
  • Hannah Tamary
  • Elhanan Nahum
  • Ran Steinberg
  • Enrique Freud
Original Article

Abstract

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.

Conclusions: Rarely, an emergency splenectomy is required in complex settings, mostly refractory hematological conditions, in a deteriorating patient when all other measurements have failed. A multidisciplinary team approach is mandatory in the treatment of these complex cases.

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.

Keywords

Emergency splenectomy Non-traumatic Children 

Abbreviations

ALL

Acute lymphoblastic leukemia

AML

Acute myeloid leukemia

CML

Chronic myeloid leukemia

CT scan

Computerized tomography scan

CVA

Cerebrovascular accident

ITP

Immune thrombocytopenic purpura

Notes

Authors’ contributions

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.

Ethical approval

This article does not contain any study with human participants or animals performed by any of the authors.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Inbal Samuk
    • 1
  • Emmanuelle Seguier-Lipszyc
    • 1
    Email author
  • Artur Baazov
    • 1
  • Hannah Tamary
    • 2
  • Elhanan Nahum
    • 3
  • Ran Steinberg
    • 4
  • Enrique Freud
    • 5
  1. 1.Department of Pediatric and Adolescent Surgery, Schneider Children’s Medical Center of Israel, Sackler School of MedicineTel Aviv UniversityPetah TikvaIsrael
  2. 2.Head of Hematology Unit, Schneider Children’s Medical Center of Israel, Sackler School of MedicineTel Aviv UniversityTel Aviv-YafoIsrael
  3. 3.Head of Department of Pediatric Intensive Care Unit, Schneider Children’s Medical Center of Israel, Sackler School of MedicineTel Aviv UniversityTel Aviv-YafoIsrael
  4. 4.Head of Department of Pediatric Surgery, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, Rappaport Faculty of MedicineTechnion-Israel Institute of TechnologyHaifaIsrael
  5. 5.Head of Department of Pediatric and Adolescent Surgery, Schneider Children’s Medical Center of Israel, Sackler School of MedicineTel Aviv UniversityTel Aviv-YafoIsrael

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