Surgical treatment of massive splenomegaly and severe hypersplenism secondary to extrahepatic portal venous obstruction in children.
OBJECTIVE
Massive splenomegaly with severe hypersplenism can occur as a late complication of portal hypertension (PH) caused by extrahepatic portal venous obstruction (EHPVO) in children. Severe hypersplenism is often refractory to treatment with endoscopic sclerotherapy (EST) and shunt surgery. We report our experience of managing this disorder surgically.


METHODS
We performed splenectomy and esophagogastric devascularization via laparotomy in 14 children with an average age of 9.7 years. Upper gastrointestinal endoscopy had shown esophageal varices of varying grade, and EST had been done for patients with a history of bleeding. The indications for surgery were pain and discomfort caused by a large spleen greater than 15 cm below the costal margin, and intractable symptomatic hypersplenism with a total leukocyte count <2500/mm3 and a platelet count <50,000/mm3, or both.


RESULTS
Postoperative recovery was uneventful and the leukocyte and platelet counts reverted to normal. After follow-up for 1-5 years, all 14 children were asymptomatic, with improved growth and nutrition and no reported episodes of gastrointestinal bleeding, sepsis, or encephalopathy.


CONCLUSIONS
Splenectomy with devascularization is effective for children with massive splenomegaly and severe hypersplenism secondary to EHPVO.
Subhasis
Roy Choudhury
RC
Department of Pediatric Surgery, Lady Hardinge Medical College, New Delhi 110001, India.
Rajiv
Chadha
C
Kumar
Sharma Akshay
SA
Kumar
Anand Vinod
AV
Kumar
Patwari Ashok
PA
D002648:Child; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000601:surgery*; D004947:Esophagus / Q000098:blood supply; D005260:Female; D006801:Humans; D006971:Hypersplenism / Q000209:etiology / Q000601:surgery*; D006975:Hypertension, Portal / Q000150:complications*; D008297:Male; D013156:Splenectomy; D013163:Splenomegaly / Q000209:etiology / Q000601:surgery*; D013270:Stomach / Q000098:blood supply; D014656:Vascular Surgical Procedures