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Conservation of the ruptured spleen in children: an African series
1Department of Surgery, Ahmadu Bello University Hospital, Zaria, Nigeria.
Insights
Splenorrhaphy (spleen repair) is a viable surgical option for children with traumatic spleen rupture, even with enlarged spleens common in malaria-endemic regions. This spleen conservation technique offers a promising alternative to splenectomy in tropical settings.
Area of Science:
- Pediatric Surgery
- Tropical Medicine
- Trauma Management
Background:
- Traumatic spleen rupture is a significant cause of morbidity and mortality in children.
- Splenomegaly, often caused by endemic malaria and schistosomiasis, complicates spleen injury management in tropical regions.
- Surgical intervention for splenic trauma is critical, with splenectomy historically being the primary approach.
Purpose of the Study:
- To evaluate the feasibility and outcomes of splenorrhaphy versus splenectomy in children with traumatic spleen rupture.
- To assess the efficacy of spleen repair techniques in both normal-sized and enlarged spleens.
- To provide surgical recommendations for managing splenic trauma in malaria- and schistosomiasis-endemic areas.
Main Methods:
- A retrospective analysis of 27 children undergoing laparotomy for traumatic spleen rupture in Zaria, Nigeria.
- Surgical repair (splenorrhaphy) was performed on 17 ruptured spleens, with one partial resection.
- Total splenectomy was performed in nine cases.
Main Results:
- Splenorrhaphy was successfully performed on both normal and enlarged spleens.
- Five children in the splenic conservation group died due to associated severe injuries, not spleen repair failure.
- No mortality was directly attributed to the splenorrhaphy procedure itself.
Conclusions:
- Splenorrhaphy is a feasible and effective surgical technique for traumatic spleen rupture in children, including those with splenomegaly.
- Spleen conservation should be encouraged in tropical countries with high prevalence of splenomegaly due to endemic infections.
- This approach may reduce the long-term complications associated with splenectomy in pediatric trauma patients.
Abstract:
In the Zaria region of northern Nigeria, which is endemic for malaria and schistosomiasis, laparotomy was performed for traumatic rupture of the spleen in 27 children, 10 of whom had splenomegaly. Eleven of the children were pedestrians knocked down by motor vehicles while crossing the road and six were boys who fell off mango or guava trees. Using suture techniques, 17 ruptured spleens were repaired and one was partially resected: eight of them were enlarged. Total splenectomy was performed in nine cases. Five of the children in the splenic conservation group died within 4 days of surgery owing to severe associated injuries. It is concluded that splenorrhaphy is quite feasible in both normal-sized and enlarged spleens and should be encouraged in similar tropical countries where splenomegaly is a common response to endemic malaria and schistosoma.