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Complications after elective splenectomy in children
Insights
Pediatric splenectomies for hematological disorders carry a sepsis risk. While rare, pneumococcal sepsis occurred in two cases, highlighting the need for spleen-saving surgery and pneumococcal vaccination post-splenectomy.
Area of Science:
- Pediatric Surgery
- Hematology
- Infectious Diseases
Background:
- Elective splenectomies were performed on 112 children (aged 0-14) between 1968-1977.
- Indications primarily included hematological disorders like hereditary spherocytosis and idiopathic thrombocytopenia.
Purpose of the Study:
- To review outcomes of pediatric splenectomies.
- To assess the risk of overwhelming sepsis in asplenic children.
Main Methods:
- Retrospective review of 112 pediatric splenectomies.
- Follow-up inquiries sent to assess sepsis development.
Main Results:
- Two cases of nonfatal pneumococcal septicemia were reported.
- The incidence of sepsis, though low, indicates a significant risk.
Conclusions:
- Spleen-saving operations are preferable when feasible.
- Pneumococcal antibody titers should be determined post-splenectomy.
- Polyvalent pneumococcal vaccine is recommended for children with low antibody titers.
Abstract:
Elective splenectomies performed in children aged 0-14 during the period 1968 to 1977 have been reviewed. One hundred and twelve children were splenectomized during the period studied. The indication for splenectomy was usually a haematological disorder e.g. hereditary spherocytosis or idiopathic thrombocytopenia. As splenectomized children run the risk of developing overwhelming sepsis, inquiries have been sent to all children. Two cases of nonfatal pneumococcal septicaemia are reported. Although the incidence of septicaemia is low, spleensaving operations are to be preferred where possible. When splenectomy is performed, pneumococcal antibodies should be determined. If a low titre is found, polyvalent pneumococcal vaccine should be used.