BACKGROUND: Non-operative management for blunt splenic injuries was introduced to reduce the risk of overwhelming post splenectomy infection in children. To increase splenic preservation rates, splenic artery embolization (SAE) was added to our institutional treatment protocol in 2002. In the presence of clinical signs of ongoing bleeding, SAE was considered also in children. To our knowledge, the long term splenic function after SAE performed in the paediatric population has not been evaluated and constitutes the aim of the present study. METHODS: A total of 11 SAE patients less than 17 years of age at the time of injury were included with 11 healthy volunteers serving as matched controls. Clinical examination, medical history, general blood counts, immunoglobulin quantifications and flowcytometric analysis of lymphocyte phenotypes were performed. Peripheral blood smears were examined for Howell-Jolly bodies (H-J bodies) and abdominal ultrasound was performed in order to assess the size and perfusion of the spleen. RESULTS: On average 4.6 years after SAE (range 1-8 years), no significant differences could be detected between the SAE patients and their controls. Total and Pneumococcus serospecific immunoglobulins and H-J bodies did not differ between the study groups, nor did general blood counts and lymphocyte numbers, including memory B cell proportions. The ultrasound examinations revealed normal sized and well perfused spleens in the SAE patients when compared to their controls. CONCLUSION: This case control study indicates preserved splenic function after SAE for splenic injury in children. Mandatory immunization to prevent severe infections does not seem warranted.
BACKGROUND: Non-operative management for blunt splenic injuries was introduced to reduce the risk of overwhelming post splenectomy infection in children. To increase splenic preservation rates, splenic artery embolization (SAE) was added to our institutional treatment protocol in 2002. In the presence of clinical signs of ongoing bleeding, SAE was considered also in children. To our knowledge, the long term splenic function after SAE performed in the paediatric population has not been evaluated and constitutes the aim of the present study. METHODS: A total of 11 SAEpatients less than 17 years of age at the time of injury were included with 11 healthy volunteers serving as matched controls. Clinical examination, medical history, general blood counts, immunoglobulin quantifications and flowcytometric analysis of lymphocyte phenotypes were performed. Peripheral blood smears were examined for Howell-Jolly bodies (H-J bodies) and abdominal ultrasound was performed in order to assess the size and perfusion of the spleen. RESULTS: On average 4.6 years after SAE (range 1-8 years), no significant differences could be detected between the SAEpatients and their controls. Total and Pneumococcus serospecific immunoglobulins and H-J bodies did not differ between the study groups, nor did general blood counts and lymphocyte numbers, including memory B cell proportions. The ultrasound examinations revealed normal sized and well perfused spleens in the SAEpatients when compared to their controls. CONCLUSION: This case control study indicates preserved splenic function after SAE for splenic injury in children. Mandatory immunization to prevent severe infections does not seem warranted.
Authors: Mauro Podda; Belinda De Simone; Marco Ceresoli; Francesco Virdis; Francesco Favi; Johannes Wiik Larsen; Federico Coccolini; Massimo Sartelli; Nikolaos Pararas; Solomon Gurmu Beka; Luigi Bonavina; Raffaele Bova; Adolfo Pisanu; Fikri Abu-Zidan; Zsolt Balogh; Osvaldo Chiara; Imtiaz Wani; Philip Stahel; Salomone Di Saverio; Thomas Scalea; Kjetil Soreide; Boris Sakakushev; Francesco Amico; Costanza Martino; Andreas Hecker; Nicola de'Angelis; Mircea Chirica; Joseph Galante; Andrew Kirkpatrick; Emmanouil Pikoulis; Yoram Kluger; Denis Bensard; Luca Ansaloni; Gustavo Fraga; Ian Civil; Giovanni Domenico Tebala; Isidoro Di Carlo; Yunfeng Cui; Raul Coimbra; Vanni Agnoletti; Ibrahima Sall; Edward Tan; Edoardo Picetti; Andrey Litvin; Dimitrios Damaskos; Kenji Inaba; Jeffrey Leung; Ronald Maier; Walt Biffl; Ari Leppaniemi; Ernest Moore; Kurinchi Gurusamy; Fausto Catena Journal: World J Emerg Surg Date: 2022-10-12 Impact factor: 8.165
Authors: Federico Coccolini; Giulia Montori; Fausto Catena; Yoram Kluger; Walter Biffl; Ernest E Moore; Viktor Reva; Camilla Bing; Miklosh Bala; Paola Fugazzola; Hany Bahouth; Ingo Marzi; George Velmahos; Rao Ivatury; Kjetil Soreide; Tal Horer; Richard Ten Broek; Bruno M Pereira; Gustavo P Fraga; Kenji Inaba; Joseph Kashuk; Neil Parry; Peter T Masiakos; Konstantinos S Mylonas; Andrew Kirkpatrick; Fikri Abu-Zidan; Carlos Augusto Gomes; Simone Vasilij Benatti; Noel Naidoo; Francesco Salvetti; Stefano Maccatrozzo; Vanni Agnoletti; Emiliano Gamberini; Leonardo Solaini; Antonio Costanzo; Andrea Celotti; Matteo Tomasoni; Vladimir Khokha; Catherine Arvieux; Lena Napolitano; Lauri Handolin; Michele Pisano; Stefano Magnone; David A Spain; Marc de Moya; Kimberly A Davis; Nicola De Angelis; Ari Leppaniemi; Paula Ferrada; Rifat Latifi; David Costa Navarro; Yashuiro Otomo; Raul Coimbra; Ronald V Maier; Frederick Moore; Sandro Rizoli; Boris Sakakushev; Joseph M Galante; Osvaldo Chiara; Stefania Cimbanassi; Alain Chichom Mefire; Dieter Weber; Marco Ceresoli; Andrew B Peitzman; Liban Wehlie; Massimo Sartelli; Salomone Di Saverio; Luca Ansaloni Journal: World J Emerg Surg Date: 2017-08-18 Impact factor: 5.469