Emergency
splenectomy is rarely performed since a widespread consensus exists towards
conservative management of splenic injury. However, in selected conditions, mainly hematological, there is a role for emergency or urgent
splenectomy. This study aims to retrospectively review these cases and discuss outcome in relation to the pre-existing splenic pathologies. Between 2000 and 2015, 12 patients, five girls, and seven boys, with a median age of six years (3 months-13.11 years), underwent emergency or urgent
splenectomy for non-traumatic conditions. All patients had major associated disorders; mainly hematological (11 cases) including
hemolytic anemia with
pancytopenia (1),
sickle cell anemia (1), AML (1), ALL (2), CML (1),
T cell lymphoma (1),
Burkitt lymphoma (1), and
ITP (3). One patient had a microvillous
inclusion disease. Indications for
splenectomy included diffuse resistant splenic
abscesses (4),
intracranial hemorrhage (4) or
hypersplenism (3) with refractory
thrombocytopenia, and spontaneous splenic rapture (1). Nine patients improved following surgery but three died, owing to massive
intracranial hemorrhage (1) and severe
respiratory failure (2) despite aggressive management.Conclusions: Rarely, an emergency
splenectomy is required in complex settings, mostly refractory hematological conditions, in a deteriorating patient when all other measurements have failed. A multidisciplinary team approach is mandatory in the treatment of these complex cases. What is known •
Conservative treatment is advised for splenic injury. • Many hematological disorders are responsible of splenic pathology. What is new • Emergency
splenectomy in children for reasons other than
trauma is a treatment of last resort that should be performed in a multidisciplinary context. • The outcome of emergency
splenectomy in children for reasons other than
trauma depends on the underlying medical condition.