PARTIAL SPLENIC EMBOLIZATION THERAPY FOR HYPERSPLENISM OF VARIOUS ORIGIN

Problem: Splenectomy in young patients leads to a high rate of overwel ming post-splenectomy infection. In addition,the immunologic competenc e of young children does not evolve as usual, resulting in an increase d risk for certain bacterial infections. Here we present partial splen ic embolisation for hyperplenism as an alternative to surgical splenec tomy. Method, patients: In 4 children (age 13 to 84 month, median 43 m onths) with severe hypersplenism of various origin a selective splenic embolisation was performed successfully. By selective catheterisation low-molecular-weight particles were injected into splenic arteries. T his partial embolisation led to a segmental occlusion of peripheral sp lenic areas. After the procedure the patients received morphine infusi ons as analgesic and an antibiotic treatment with ampicillin and tobra mycin, so that either attacks of pain nor infections occured One patie nt developed brief ileus symptoms and fever directly after embolisatio n. The patients were discharged after 5 to 10 days. Results: Hematolog ic parameters improved within a few days in all patients, thus transfu sions were no longer necessary. One patient with an unidentified syndr ome with dysmorphia died of pneumonia and septicemia 26 months after e mbolisation. At this lime he had developed histological signs of lymph ohistiocytosis as underlying disease. Three patients are in a good con dition now with markedly reduced susceptibility to infection after a m ean observation period of 30 months. A relapse of hypersplenism was no t seen under regular follow-up, hematologic parameters remained normal or improved in one patient. Conclusion: In our opinion partial spleni c embolisation in children with hyperplenism requiring frequent transf usions is an alternative to splenectomy, being less invasive and with fewer risks.