[Splenectomy and reimplantation of splenic tissue in children]

Abstract

161 splenectomies are presented with a morbidity of 14.8% and a total mortality rate of 4.3%. The lethality rate due to severe infections (-3.9%), however, was high and mostly caused by an overwhelming postsplenectomy sepsis, pneumonia or meningitis. 61.5% of the infections were caused by pneumococcus. To drop that high lethality rate after splenectomy we replanted splenic tissue in seven patients. Scintigraphic investigations showed in all cases well vascularised splenic tissue. The immunoglobulins were in a normal range. Howell-Jolly bodies, however, did not disappear in all the patients. From our study as well as from the literature one has to conclude that replanted splenic tissue requires immunologic activity but a reduced capacity for phagocytosis. Therefore, in cases of traumatic injury to the spleen it is necessary to try to preserve as much of the organ as possible either by infrared coagulation, gluing with human fibrinogen or partial splenectomy. If these procedures are impossible a replantation of--50% of the original splenic tissue should be done and several thin homogenised particles replanted intra- or retroperitoneally. Out of that a preoperative vaccination against pneumococcal infection is necessary as well as a postoperative penicillin prophylaxis for about three years.