Low Morbidity Profile of Spleen Mesh Wrapping in Children

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

References

• 1 Bochicchio G V, Arciero C, Scalea T M. The hemostatic wrap: a new technique in splenorrhaphy.  J Trauma. 2005;  59 1003-1006
• 2 Buess E, Illi O E, Soder C, Harrimann B. Ruptured spleen in children - 15 year evolution in therapeutic concepts.  Eur J Pediatr Surg. 1992;  2 157-161
• 3 Davis K A, Fabian T C, Croce M A, Gavant M L, Flick P A, Minard G, Kudsk K A, Pritchard F E. Improved success in nonoperative management of blunt splenic injuries: embolization of splenic artery pseudoaneurysm.  J Trauma. 1998;  44 1008-1015
• 4 Drugas D, Duarte B, Robin A, Barrett J. Salmonella typhi splenic abscess in an intravenous drug abuser following splenorrhaphy: case report.  J Trauma. 1992;  33 143-144
• 5 Fingerhut A, Oberlin P, Cotte J L, Aziz L, Etienne J C, Vinson-Bonnet B, Aubert J D, Rea S. Splenic salvage using an absorbable mesh: possibility, reliability and safety.  Br J Surg. 1992;  79 325-327
• 6 Frumiento C, Sartorelli K, Vane B. Complications of splenic injuries: expansion of the nonoperative theories.  J Pediatr Surg. 2000;  35 788-791
• 7 Gow K W, Murphy 3rd J J. Splanchnic artery pseudo-aneurysms secondary to blunt abdominal trauma in children.  J Pediatr Surg. 1996;  31 812-815
• 8 Hiraide A, Yamamoto H, Yahata K. Delayed rupture of spleen caused by an intrasplenic pseudoaneurysm following blunt trauma: case report.  J Trauma. 1994;  36 743-744
• 9 Iuchtman M, Alfici R, Sternberg E, Trost L, Litmanovich M. Multimodality management in severe pediatric spleen trauma.  Isr Med Assoc J. 2000;  2 523-525
• 10 Lange D A, Zaret P, Merlotti G J, Robin A P, Sheaff C, Barrett J A. The use of absorbable mesh in splenic trauma.  J Trauma. 1988;  28 269-275
• 11 Linos D A, Nagorney D M, McIllrath D C. Splenic abscess: the importance of early diagnosis.  Mayo Clinic Proc. 1983;  58 261-264
• 12 Martinez S R, Young S E, Brebbia J S. Small bowel obstruction after absorbable mesh wraps splenorrhaphy.  Internet J Surg. 2005;  6 1528-1542
• 13 Noterdaema P M, Versmassen F, Derom F. Spleen preserving surgery using a polyglactin (Vicryl) perisplenic prosthesis.  Acta Chir Belg. 1987;  87 282-286
• 14 Pachter H L, Spencer F C, Hofstetter S R, Liang H G, Hoballah J, Coppa G F. Experience with selective operative and nonoperative treatment of splenic injuries in 193 patients.  Ann Surg. 1990;  211 583-591
• 15 Paya K, Wurm J, Graf M, Pichler P, Oertl M, Mayerhoffer W, Engels M. Intrasplenic posttraumatic pseudoaneurysm secondary to spleen-salvaging surgery.  J Trauma. 2002;  52 783-785
• 16 Pickhardt B, Moore E E, Moore F A, McCrosky B L, Moore G E. Operative splenic salvage in adults. A decade perspective.  J Trauma. 1989;  29 1386-1391
• 17 Rogers F B, Baumgartner N E, Robin A P, Barrett J A. Absorbable mesh splenorrhaphy for severe splenic injuries: functional studies in an animal model and an additional patient series.  J Trauma. 1991;  31 200-204
• 18 Sondenaa K, Tasdemir I, Anderson E, Skadberg J E, Soreided J A. Treatment of blunt injury of the spleen: is there a place for mesh wrapping?.  Eur J Surg. 1994;  160 669-673
• 19 Tribble C G, Joob A W, Barone G W, Rogers B M. A new technique for wrapping the injured spleen with polyglactin mesh.  Am Surg. 1987;  53 661-663
• 20 Witte C L, Esser M J, Rappaport W D. Updating the management of salvageable splenic injury.  Ann Surg. 1992;  215 261-265