title: Preserved function after angioembolisation of splenic injury in children and adolescents: a case control study.
abstract: BACKGROUND
  Non-operative management for blunt splenic injuries was introduced to reduce the risk of overwhelming post splenectomy infection in children. To increase splenic preservation rates, splenic artery embolization (SAE) was added to our institutional treatment protocol in 2002. In the presence of clinical signs of ongoing bleeding, SAE was considered also in children. To our knowledge, the long term splenic function after SAE performed in the paediatric population has not been evaluated and constitutes the aim of the present study.
  
  
  METHODS
  A total of 11 SAE patients less than 17 years of age at the time of injury were included with 11 healthy volunteers serving as matched controls. Clinical examination, medical history, general blood counts, immunoglobulin quantifications and flowcytometric analysis of lymphocyte phenotypes were performed. Peripheral blood smears were examined for Howell-Jolly bodies (H-J bodies) and abdominal ultrasound was performed in order to assess the size and perfusion of the spleen.
  
  
  RESULTS
  On average 4.6 years after SAE (range 1-8 years), no significant differences could be detected between the SAE patients and their controls. Total and Pneumococcus serospecific immunoglobulins and H-J bodies did not differ between the study groups, nor did general blood counts and lymphocyte numbers, including memory B cell proportions. The ultrasound examinations revealed normal sized and well perfused spleens in the SAE patients when compared to their controls.
  
  
  CONCLUSIONS
  This case control study indicates preserved splenic function after SAE for splenic injury in children. Mandatory immunization to prevent severe infections does not seem warranted.
authors.affiliation: Department of Traumatology, Oslo University Hospital Ulleval, PO Box 4950, Nydalen, N-0424 Oslo, Norway. Electronic address: joet@uus.no.
authors.forename: Jorunn
authors.initials: J
authors.lastname: Skattum
authors.forename: Ruth Jeanette Vaaler
authors.initials: RJ
authors.lastname: Loekke
authors.forename: Thomas Larsen
authors.initials: TL
authors.lastname: Titze
authors.forename: Anne Grete
authors.initials: AG
authors.lastname: Bechensteen
authors.forename: Ingeborg S
authors.initials: IS
authors.lastname: Aaberge
authors.forename: Liv Toril
authors.initials: LT
authors.lastname: Osnes
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Heier
authors.forename: Christine
authors.initials: C
authors.lastname: Gaarder
authors.forename: Paal Aksel
authors.initials: PA
authors.lastname: Naess
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D000293:Adolescent; D001402:B-Lymphocytes / Q000276:immunology; D016022:Case-Control Studies; D002648:Child; D002985:Clinical Protocols; D004621:Embolization, Therapeutic; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005434:Flow Cytometry; D005500:Follow-Up Studies; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D012189:Retrospective Studies; D013154:Spleen / Q000000981:diagnostic imaging / Q000276:immunology / Q000293:injuries / Q000503:physiopathology*; D013156:Splenectomy; D013157:Splenic Artery / Q000000981:diagnostic imaging / Q000276:immunology / Q000503:physiopathology*; D013601:T-Lymphocytes / Q000276:immunology; D016896:Treatment Outcome; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M