[Should splenic tissue be re-implanted after splenectomy due to birth trauma?]

Splenectomy results in loss of about 1/4 of the reticulo-endothelial system and 1/3 of the lymphatic tissue. Reduced phagocytosis and "clearing" capacity are reflected in the appearance of Howell Jolly bodies, thrombocytosis and decreased circulating immune-complexes. Reduction of IgM and compensatory increase of IgG and IgA levels further indicate immunological impairment. Transitory reduction of complement activity and the number of T-lymphocytes in the first weeks post-splenectomy constitute a significant limitation of immunological function and are accompanied by low serum tuftsin levels. These factors help explain the increased susceptibility to overwhelming infection seen in splenectomized patients. The lethality rate due to sepsis has been reported to be as high as 50%. Patients with hematological disorders, with systemic malignancies and children under 4 years of age who undergo splenectomy because of abdominal trauma are at especially high risk. The most common infectious agents are Haemophilus influenzae and Pneumococcus. The present report describes 2 infants who underwent splenectomy for the treatment of splenic rupture due to birth trauma. In one case, splenic tissue was homogenized and re-implanted; in the second case, splenectomy was followed by penicillin prophylaxis. The clinical course in the latter patient was complicated by Candida meningitis.