PMID- 23184265
OWN - NLM
STAT- MEDLINE
DCOM- 20130823
LR  - 20211021
IS  - 1437-9813 (Electronic)
IS  - 0179-0358 (Linking)
VI  - 29
IP  - 3
DP  - 2013 Mar
TI  - Massive splenic infarction in children with sickle cell anemia and the role of 
      splenectomy.
PG  - 281-5
LID - 10.1007/s00383-012-3223-2 [doi]
AB  - BACKGROUND: Massive splenic infarction (MSI) is a very rare condition. Few 
      reports of splenic infarction of various etiologies including hematological and 
      non-hematological causes have been published. On the other hand, MSI in patients 
      with sickle cell anemia (SCA) is extremely rare. This report describes our 
      experience with 15 children with SCA and MSI outlining aspects of presentation, 
      diagnosis and management. PATIENTS AND METHODS: The records of all children with 
      MSI were retrospectively reviewed for age at diagnosis, sex, clinical features, 
      precipitating factors, investigations, management and outcome. RESULTS: 15 
      children (11 M: 4 F) with SCA were treated for MSI. Their mean age was 10.9 years 
      (6-17 years). All presented with severe left upper quadrant abdominal pain. In 
      nine, this was associated with nausea and vomiting. Three were febrile and all 
      had a tender splenomegaly. Their mean hemoglobin was 8.2 g/dl (5.7-11.3 g/dl), 
      mean WBC was 10.97 x 10(3) mm(-3) (3.6 x 10(3)-22.3 x 10(3) mm(-3)) and mean 
      platelet count was 263.3 x 10(3) mm(-3) (40 x 10(3)-660 x 10(3) mm(-3)). In 
      seven, there was a precipitating cause including high altitude in two, acute 
      chest syndrome in two, septicemia in two and severe vasooclusive crisis in one. 
      Abdominal ultrasound and CT scan confirmed the diagnosis of MSI which involved 
      more than half of the spleen in 12 and whole spleen in 3. All were treated with 
      IV fluids, analgesia and blood transfusion where appropriate. Eleven had 
      splenectomy because of persistent abdominal pain, three developed splenic abscess 
      and underwent splenectomy and one settled on conservative treatment. Histology 
      confirmed the diagnosis of splenic infarction in 11 and infarction with abscess 
      in the remaining 3. CONCLUSION: MSI is extremely rare in children with SCA. It 
      can develop spontaneously or precipitated by other factors namely high altitude, 
      acute chest syndrome and severe stress. Most reported cases of splenic infarction 
      are small in size, focal and can be treated conservatively. MSI, on the other 
      hand, may necessitate splenectomy for persistent symptoms or in case of 
      complications, such as abscess formation.
FAU - Al-Salem, Ahmed H
AU  - Al-Salem AH
AD  - Department of Pediatric Surgery, Maternity and Children Hospital, Dammam, Saudi 
      Arabia. ahsalsalem@hotmail.com
LA  - eng
PT  - Journal Article
DEP - 20121127
PL  - Germany
TA  - Pediatr Surg Int
JT  - Pediatric surgery international
JID - 8609169
RN  - 0 (Analgesics)
RN  - 0 (Hemoglobins)
SB  - IM
MH  - Abdominal Pain/etiology
MH  - Abscess/complications/surgery
MH  - Acute Chest Syndrome/complications
MH  - Adolescent
MH  - Altitude
MH  - Analgesics/therapeutic use
MH  - Anemia, Sickle Cell/*complications
MH  - Blood Transfusion
MH  - Child
MH  - Female
MH  - Fever/etiology
MH  - Fluid Therapy
MH  - Hemoglobins/analysis
MH  - Humans
MH  - Male
MH  - Nausea/etiology
MH  - Platelet Count
MH  - Retrospective Studies
MH  - Sepsis/complications
MH  - *Splenectomy
MH  - Splenic Infarction/diagnosis/etiology/*surgery
MH  - Splenomegaly/etiology
MH  - Vascular Diseases/complications
MH  - Vomiting/etiology
EDAT- 2012/11/28 06:00
MHDA- 2013/08/24 06:00
CRDT- 2012/11/28 06:00
PHST- 2012/11/14 00:00 [accepted]
PHST- 2012/11/28 06:00 [entrez]
PHST- 2012/11/28 06:00 [pubmed]
PHST- 2013/08/24 06:00 [medline]
AID - 10.1007/s00383-012-3223-2 [doi]
PST - ppublish
SO  - Pediatr Surg Int. 2013 Mar;29(3):281-5. doi: 10.1007/s00383-012-3223-2. Epub 2012 
      Nov 27.