Abstract
Purpose: Spleen mesh wrapping is a valuable and efficacious technique for treating severely
traumatized spleens. We report the morbidity of the procedure and describe its management
in children. Methods: A retrospective survey of children admitted to the Hillel Yaffe Medical Center with
a traumatized spleen was carried out. Results: Between 1985 and 2000, we treated 168 children for blunt spleen trauma. The spleen
was the only intra-abdominal organ injured in 102 of them. Absorbable mesh wrapping
was chosen for 20 children (age range 1 - 15 years), with grade III/IV lesions that
would otherwise probably have required splenectomy. Hemostasis was achieved in all
20 children. All children survived with intact spleens as suggested by the absence
of long-term infectious complications and by normal hematological, US and scintigraphy
studies. Anti-pneumococcal vaccination was not required. Complications were diagnosed
in 12 cases, the most common being prolonged fever. Perisplenic fluid, oozing, and
left pleural effusion were also present. Only one intrasplenic pseudoaneurysm occurred
and this resolved spontaneously. There was one splenic abscess which was successfully
treated by transmesh transcutaneous computerized tomography-guided drainage. No complications
were detected at the 1 year follow-up. Conclusions: Absorbable mesh wrapping is safe and effective for treating grade III/IV spleen ruptures
in children. Complications are mostly minor, and resolve spontaneously. Major complications
are rare and can usually be managed nonsurgically.
Key words
trauma - spleen trauma - mesh wrapping - complications
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Dr. Zvi Steiner
Hillel Yaffe Medical Center
Department of Pediatric Surgery
P. O. Box 169
38100 Hadera
Israel
Email: steiner@hy.health.gov.il
