A case of perioperative embolization in pediatric splenectomy for massive splenomegaly
Anders SandinAbstract
Introduction
Laparoscopic splenectomy is the preferred approach in children with massive splenomegaly. However, massive splenomegaly increases the technical difficulty of performing the procedure. Perioperative arterial embolization may be considered to reduce splenic size, intraoperative blood loss, and the risk of conversion to open surgery. We describe the case of a 10-year-old child with hereditary spherocytosis and an indication for splenectomy due to hyperbilirubinemia, anemia, and fatigue. Preoperative imaging revealed a massively enlarged spleen measuring 25 × 12 cm.
Methods
An interventional radiologist performed the preoperative embolization of the splenic artery in the operating room. Embolization particles and a coil were placed distally in the splenic artery, beyond the last branch of the pancreatic artery. The spleen measured 25 cm in length on preoperative ultrasound and 20 cm following embolization, as assessed by a radiologist.
Results
The procedure was performed laparoscopically, with ports placed in the lower abdomen. Intraoperative blood loss was minimal, and the reduction in splenic size to 20 cm facilitated visualization of anatomical landmarks and completion of the splenectomy. Due to the size of the spleen, it could not be placed in an endoscopic retrieval bag and was instead extracted through a small Pfannenstiel incision. The postoperative course was uneventful, and the patient was discharged on postoperative day 2.
Discussion
Preoperative embolization should be considered in cases of massive splenomegaly, as both open and laparoscopic splenectomy can be technically challenging. Preoperative evaluation with CT angiography is recommended, and the involvement of an interventional radiologist with experience in pediatric procedures is essential.