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The morbidity and mortality of splenectomy in childhood
Insights
Children who undergo splenectomy face a significant risk of serious infections, particularly sepsis, within two years post-surgery. Pneumococcus is a common pathogen, leading to high mortality rates in these patients.
Area of Science:
- Pediatric Surgery
- Infectious Diseases
- Immunology
Background:
- Splenectomy, the surgical removal of the spleen, is performed for various pediatric conditions.
- The spleen plays a crucial role in immune function, particularly in clearing encapsulated bacteria.
Purpose of the Study:
- To assess the long-term risk of serious infections following splenectomy in children.
- To identify factors influencing infection risk and outcomes after pediatric splenectomy.
Main Methods:
- A retrospective follow-up study of 182 pediatric patients who underwent splenectomy.
- Data collection included infection incidence, causative organisms, timing, and mortality over 2 to 15 years.
Main Results:
- Serious infections occurred in 6% of patients, with a 3.3% mortality rate.
- Sepsis was the most common serious infection, predominantly occurring within 2 years of splenectomy.
- Splenectomy for thalassemia and portal hypertension carried a higher infection risk compared to other indications like trauma or hereditary spherocytosis.
Conclusions:
- Pediatric splenectomy, especially for certain conditions, significantly increases the risk of life-threatening infections.
- Prompt recognition and management are crucial due to the fulminating nature and high mortality of post-splenectomy infections, often caused by pneumococcus.
Abstract:
One hundred and eighty-two patients undergoing splenectomy in infancy and childhood were followed for periods of 2 to 15 years. Serious infections occurred in 11 patients (6%) with death in 6 (3.3%). In 10 patients the infection was sepsis, and in all but one patient the infection occurred within 2 years of splenectomy. Among children over 2 years of age the risk of infection was still appreciable except when the spleen was removed incidentally or for traumatic rupture. Splenectomy for thalassemia and portal hypertension resulted in an increased risk of serious infections when compared with removal of the spleen for hereditary spherocytosis, idiopathic thrombocytopenic purpura, trauma, or for technical reasons in the course of another operation. Post-splenectomy infections tended to follow a characteristic pattern. The infecting organism was predominantly pneumococcus, the course was fulminating and the mortality high.