Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1977 Mar;185(3):307–310. doi: 10.1097/00000658-197703000-00010

The morbidity and mortality of splenectomy in childhood.

S H Ein, B Shandling, J S Simpson, C A Stephens, S K Bandi, W D Biggar, M H Freedman
PMCID: PMC1396609  PMID: 557312

Abstract

One hundred and eighty-two patients undergoing splenectomy in infancy and childhood were followed for periods of 2 to 15 years. Serious infections occurred in 11 patients (6%) with death in 6 (3.3%). In 10 patients the infection was sepsis, and in all but one patient the infection occurred within 2 years of splenectomy. Among children over 2 years of age the risk of infection was still appreciable except when the spleen was removed incidentally or for traumatic rupture. Splenectomy for thalassemia and portal hypertension resulted in an increased risk of serious infections when compared with removal of the spleen for hereditary spherocytosis, idiopathic thrombocytopenic purpura, trauma, or for technical reasons in the course of another operation. Post-splenectomy infections tended to follow a characteristic pattern. The infecting organism was predominantly pneumococcus, the course was fulminating and the mortality high.

Full text

PDF
307

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Balfanz J. R., Nesbit M. E., Jr, Jarvis C., Krivit W. Overwhelming sepsis following splenectomy for trauma. J Pediatr. 1976 Mar;88(3):458–460. doi: 10.1016/s0022-3476(76)80267-3. [DOI] [PubMed] [Google Scholar]
  2. Biggar W. D., Bogart D., Holmes B., Good R. A. Impaired phagocytosis of pneumococcus type 3 in splenectomized rats. Proc Soc Exp Biol Med. 1972 Mar;139(3):903–908. doi: 10.3181/00379727-139-36263. [DOI] [PubMed] [Google Scholar]
  3. Bogart D., Biggar W. D., Good R. A. Impaired intravascular clearance of pneumococcus type-3 following splenectomy. J Reticuloendothel Soc. 1972 Jan;11(1):77–87. [PubMed] [Google Scholar]
  4. CARLISLE H. N., SASLAW S. Properdin levels in splenectomized persons. Proc Soc Exp Biol Med. 1959 Oct;102:150–154. doi: 10.3181/00379727-102-25173. [DOI] [PubMed] [Google Scholar]
  5. Constantopoulos A., Najjar V. A., Wish J. B., Necheles T. H., Stolbach L. L. Defective phagocytosis due to tuftsin deficiency in splenectomized subjects. Am J Dis Child. 1973 May;125(5):663–665. doi: 10.1001/archpedi.1973.04160050017004. [DOI] [PubMed] [Google Scholar]
  6. ELLIOTT R. H., Jr, REEMTSMA K. Splenectomy in Mediterranean anemia: an evaluation of long-term results. Ann Surg. 1956 Dec;144(6):999–1007. doi: 10.1097/00000658-195612000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Eraklis A. J., Filler R. M. Splenectomy in childhood: a review of 1413 cases. J Pediatr Surg. 1972 Aug-Sep;7(4):382–388. doi: 10.1016/0022-3468(72)90006-1. [DOI] [PubMed] [Google Scholar]
  8. Eraklis A. J., Kevy S. V., Diamond L. K., Gross R. E. Hazard of overwhelming infection after splenectomy in childhood. N Engl J Med. 1967 Jun 1;276(22):1225–1229. doi: 10.1056/NEJM196706012762203. [DOI] [PubMed] [Google Scholar]
  9. GOFSTEIN R., GELLIS S. S. Splenectomy in infancy and childhood; the question of overwhelming infection following operation. AMA J Dis Child. 1956 Jun;91(6):566–569. doi: 10.1001/archpedi.1956.02060020568007. [DOI] [PubMed] [Google Scholar]
  10. Gavrilis P., Rothenberg S. P., Guy R. Correlation of low serum IgM levels with absence of functional splenic tissue in sickle cell disease syndromes. Am J Med. 1974 Oct;57(4):542–545. doi: 10.1016/0002-9343(74)90004-7. [DOI] [PubMed] [Google Scholar]
  11. HORAN M., COLEBATCH J. H. Relation between splenectomy and subsequent infection. A clinical study. Arch Dis Child. 1962 Aug;37:398–414. doi: 10.1136/adc.37.194.398. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. KING H., SHUMACKER H. B., Jr Splenic studies. I. Susceptibility to infection after splenectomy performed in infancy. Ann Surg. 1952 Aug;136(2):239–242. doi: 10.1097/00000658-195208000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. LASKI B., MACMILLAN A. Incidence of infection in children after splenectomy. Pediatrics. 1959 Oct;24:523–527. [PubMed] [Google Scholar]
  14. LUCAS R. V., Jr, KRIVIT W. Overwhelming infection in children following splenectomy. J Pediatr. 1960 Aug;57:185–191. doi: 10.1016/s0022-3476(60)80052-2. [DOI] [PubMed] [Google Scholar]
  15. Lowdon A. G., Stewart R. H., Walker W. Risk of serious infection following splenectomy. Br Med J. 1966 Feb 19;1(5485):446–450. doi: 10.1136/bmj.1.5485.446. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. ROBINSON T. W., STURGEON P. Post-splenectomy infection in infants and children. Pediatrics. 1960 Jun;25:941–951. [PubMed] [Google Scholar]
  17. ROWLEY D. A. The formation of circulating antibody in the splenectomized human being following intravenous injection of heterologous erythrocytes. J Immunol. 1950 Nov;65(5):515–521. [PubMed] [Google Scholar]
  18. SMITH C. H., ERLANDSON M., SCHULMAN I., STERN G. Hazard of severe infections in splenectomized infants and children. Am J Med. 1957 Mar;22(3):390–404. doi: 10.1016/0002-9343(57)90095-5. [DOI] [PubMed] [Google Scholar]
  19. Schulkind M. L., Ellis E. F., Smith R. T. Effect of antibody upon clearance of I-125-labelled pneumococci by the spleen and liver. Pediatr Res. 1967 May;1(3):178–184. doi: 10.1203/00006450-196705000-00004. [DOI] [PubMed] [Google Scholar]
  20. Schumacher M. J. Serum immunoglobulin and transferrin levels after childhood splenectomy. Arch Dis Child. 1970 Feb;45(239):114–117. doi: 10.1136/adc.45.239.114. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Wasi C., Wasi P., Thongcharoen P. Serum-immunoglobulin levels in thalassaemia and the effects of splenectomy. Lancet. 1971 Jul 31;2(7718):237–239. doi: 10.1016/s0140-6736(71)92573-6. [DOI] [PubMed] [Google Scholar]
  22. Winkelstein J. A., Lambert G. H., Swift A. Pneumococcal serum opsonizing activity in splenectomized children. J Pediatr. 1975 Sep;87(3):430–433. doi: 10.1016/s0022-3476(75)80652-4. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES