Related Experiment Videos
Preserved function after angioembolisation of splenic injury in children and adolescents: a case control study
Jorunn Skattum1, Ruth Jeanette Vaaler Loekke, Thomas Larsen Titze
1Department of Traumatology, Oslo University Hospital Ulleval, PO Box 4950, Nydalen, N-0424 Oslo, Norway.
Insights
Splenic artery embolization (SAE) in children with blunt splenic injuries preserves long-term spleen function. This study found no significant differences in spleen function or health markers between treated children and healthy controls, suggesting SAE is a safe and effective treatment.
Area of Science:
- Pediatric surgery
- Interventional radiology
- Immunology
Background:
- Non-operative management of blunt splenic injuries aims to prevent overwhelming post-splenectomy infection in children.
- Splenic artery embolization (SAE) was integrated into treatment protocols to enhance splenic preservation rates.
- The long-term splenic function following SAE in pediatric patients remained unevaluated.
Purpose of the Study:
- To evaluate the long-term splenic function in children who underwent splenic artery embolization (SAE) for blunt splenic injuries.
Main Methods:
- A case-control study included 11 pediatric patients (under 17) who underwent SAE and 11 matched healthy controls.
- Evaluations included clinical exams, medical history, blood counts, immunoglobulin levels, flow cytometry, peripheral blood smear analysis for Howell-Jolly bodies, and abdominal ultrasound.
- Spleen size and perfusion were assessed via ultrasound, and immune function was evaluated through immunoglobulin and lymphocyte analysis.
Main Results:
- After an average of 4.6 years post-SAE, no significant differences were observed between SAE patients and controls.
- Key findings included comparable levels of total and Pneumococcus serospecific immunoglobulins, absence of significant differences in Howell-Jolly bodies, general blood counts, and lymphocyte populations (including memory B cells).
- Ultrasound revealed normal spleen size and perfusion in SAE patients compared to controls.
Conclusions:
- This study indicates that splenic artery embolization (SAE) for splenic injury in children leads to preserved splenic function.
- Routine immunizations to prevent severe infections may not be necessary for children treated with SAE.
- SAE represents a viable option for managing blunt splenic injuries in pediatric patients, maintaining splenic function.
Background:
Non-operative management for blunt splenic injuries was introduced to reduce the risk of overwhelming post splenectomy infection in children. To increase splenic preservation rates, splenic artery embolization (SAE) was added to our institutional treatment protocol in 2002. In the presence of clinical signs of ongoing bleeding, SAE was considered also in children. To our knowledge, the long term splenic function after SAE performed in the paediatric population has not been evaluated and constitutes the aim of the present study.
Methods:
A total of 11 SAE patients less than 17 years of age at the time of injury were included with 11 healthy volunteers serving as matched controls. Clinical examination, medical history, general blood counts, immunoglobulin quantifications and flowcytometric analysis of lymphocyte phenotypes were performed. Peripheral blood smears were examined for Howell-Jolly bodies (H-J bodies) and abdominal ultrasound was performed in order to assess the size and perfusion of the spleen.
Results:
On average 4.6 years after SAE (range 1-8 years), no significant differences could be detected between the SAE patients and their controls. Total and Pneumococcus serospecific immunoglobulins and H-J bodies did not differ between the study groups, nor did general blood counts and lymphocyte numbers, including memory B cell proportions. The ultrasound examinations revealed normal sized and well perfused spleens in the SAE patients when compared to their controls.
Conclusion:
This case control study indicates preserved splenic function after SAE for splenic injury in children. Mandatory immunization to prevent severe infections does not seem warranted.
