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Preoperative embolization of the spleen in children with hypersplenism
M P Hickman1, D Lucas, Z Novak
1Department of Radiology, University of Tennessee, Memphis.
Insights
Preoperative splenic artery embolization reduced blood loss during splenectomy in children with hypersplenism. This procedure safely managed massive spleens and pancytopenia, improving surgical outcomes.
Area of Science:
- Pediatric Surgery
- Interventional Radiology
- Hematology
Background:
- Massive splenomegaly in children, often linked to myelodysplastic disorders, can cause severe pancytopenia and discomfort.
- Surgical splenectomy for hypersplenism carries significant risks, including hemorrhage due to thrombocytopenia and distorted surgical anatomy.
Purpose of the Study:
- To evaluate the efficacy and safety of preoperative splenic artery embolization in reducing intraoperative blood loss during splenectomy in pediatric patients with hypersplenism.
Main Methods:
- Splenic artery embolization was performed under general anesthesia in 11 of 12 children (age 1-11 years) prior to splenectomy.
- Embolization agents included gelatin sponge particles, Gianturco coils, or a combination.
- Hypersplenism causes included leukemia, myelodysplastic syndrome, immune thrombocytopenia, and osteopetrosis.
Main Results:
- Successful preoperative embolization was achieved in 11 out of 12 pediatric patients.
- The procedure aimed to decrease intraoperative blood loss associated with splenectomy for massive spleens.
- Embolization facilitated safer surgical splenectomies in this cohort.
Conclusions:
- Preoperative splenic artery embolization is a safe and effective method to reduce blood loss and improve surgical safety in children undergoing splenectomy for hypersplenism.
- This interventional radiology technique can mitigate the risks associated with complex splenectomies in pediatric patients with massive spleens and pancytopenia.
Abstract:
Splenomegaly associated with myelodysplastic disorders in children may be massive and can result in pancytopenia, abdominal discomfort, and respiratory distress. When these symptoms cannot be relieved by nonsurgical means, splenectomy may be indicated. Under such conditions, surgical splenectomy carries increased risks, as the thrombocytopenia is difficult to correct secondary to splenic sequestration. Additionally, the surgical anatomy is often distorted secondary to the massive spleen and dissection can be difficult. These factors can lead to uncontrollable hemorrhage. In an attempt to decrease intraoperative blood loss, the authors successfully performed preoperative splenic artery embolization in 11 of 12 children (age range, 1-11 years) with pancytopenia due to hypersplenism. Hypersplenism requiring surgical splenectomy was due to leukemia (n = 9), myelodysplastic syndrome (n = 1), immune thrombocytopenia (n = 1), and osteopetrosis (n = 1). Embolization was performed under general anesthesia, prior to surgery, with gelatin sponge particles alone, Gianturco coils alone, or a combination of polyvinyl alcohol sponge particles and Gianturco coils. Embolization allowed for safe surgical splenectomy.