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Partial splenic embolization in children with hypersplenism
Insights
Partial splenic embolization (PSE) effectively treated portal hypertension and variceal bleeding in children. This procedure corrected hypersplenism and significantly reduced bleeding episodes with minimal complications, showing promising splenic regeneration.
Area of Science:
- Pediatric Gastroenterology
- Interventional Radiology
- Hepatology
Background:
- Portal hypertension and variceal bleeding are serious complications in children, often following biliary atresia or portal vein thrombosis.
- Hypersplenism, characterized by low white blood cell and platelet counts, frequently accompanies these conditions.
- Current treatment options for pediatric portal hypertension have limitations, necessitating alternative approaches.
Purpose of the Study:
- To evaluate the safety and efficacy of partial splenic embolization (PSE) in pediatric patients with portal hypertension and variceal bleeding.
- To assess the impact of PSE on hypersplenism and the frequency of variceal hemorrhage.
- To investigate the occurrence of splenic regeneration and complications following PSE in children.
Main Methods:
- Partial splenic embolization (PSE) was performed on 11 children aged 2-9 with portal hypertension or variceal bleeding.
- Patients included those with prior portoenterostomy for biliary atresia or portal vein thrombosis.
- Outcomes were assessed by monitoring fever, white blood cell count, platelet count, bleeding episodes, complications, and through ultrasound and Tc-99m sulfur colloid scanning.
Main Results:
- PSE was successful in 10 of 11 children.
- Leukopenia and thrombocytopenia associated with hypersplenism were corrected in most patients.
- The frequency of variceal hemorrhage decreased significantly, from an average of 2.87 to 0.67 episodes per year.
- No splenic abscesses or major complications were observed.
- Ultrasound revealed typical post-embolization changes, and Tc-99m scans indicated splenic regeneration in all evaluated patients.
Conclusions:
- Partial splenic embolization is a safe and effective treatment for pediatric portal hypertension and associated variceal bleeding.
- PSE successfully corrects hypersplenism and reduces bleeding frequency in children.
- Splenic regeneration is a common finding after PSE in children, potentially occurring more frequently than in adults.
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.