Outcome Of Splenectomy For Massive Splenomegaly Due To Various Haematological Disorders In Children In Yemen
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This study was done in Al-Saudi hospital in Yemen. Aims: to study and analyze the causes of massive splenomegaly etiology, morbidity, mortality and therapeutic value of splenectomy performed for massive splenomegaly in children in Yemen. Method: Among 21 children less than 18 years old who had splenectomy for various haematological disorders 16 of them had massive splenomegaly (Spleen weight > 1000gm) and 5 patients had splenomegaly (Spleen < 1000gm ). The records of these patients were reviewed for age at operation, haematological diagnosis, indications for splenectomy, operative procedures, postoperative complications and outcome. The patients were followed up for 1: 3 years. Results: 16 children had splenectomy for massive splenomegaly there were 12 males and 4 females, their ages ranged from 5 to 15 years (mean 12.1 years). 8 (50%) had sickle cell disease, 5 (31.25%) had beta thalassemia, 1 (6.25%) had beta thalassemia major, 2 (12.5%) had thalassemia intermediate, 12 (75%) patients were positive for malaria, they were treated before surgery by anti malarial drugs. The indications for splenectomy were hypersplenism in 12, patients, splenic sequestration crisis in 3 patients, and splenic abscess in I patient. The transfusion requirements in the patient with beta thalassemia major decreased markedly postoperatively from 20 transfusions per year to only 3 transfusions per year. Patients with thalassemia intermediate required no more blood transfusion and for those with hypersplenism there was a marked improvement in their blood parameters following splenectomy. The second group includes 5 cases with splenomegaly weighing less than 1000 gm, they were 3 males, 2 females their age ranged from 6 to 14 years all had S.C.!) and all were negative for malaria The immediate postoperative morbidity was little higher for those with massive splenomegaly, (56.25%) compared to those with splenomegaly weighing less than 1000 gm (40%). Also late post operative complication is not significant Conclusions: Massive splenomegty in children with various hematological disorders is more common in Yemen due to concomitant malarial endemic disease. With a good pen-operative management splenectomy in children with massive splenomegaly is both safe and effective.