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. |
