Splenic Rupture in Children with Portal Hypertension

Orith Waisbourd-Zinman, Amit Shah, Henry C. Lin, Elizabeth B. Rand

Research output: Contribution to journalArticle

Abstract

Introduction: Massive splenomegaly from portal hypertension (PHTN) in children raises the specter of splenic rupture; however, the incidence, etiology, and risk of rupture have not been studied, nor have existing practices to reduce risk. We therefore performed an international survey to describe the splenic rupture cases in PHTN and to describe the existing empirical practice among hepatologists. Methods: A questionnaire was constructed to elicit cases of splenic rupture and collect hepatologists' common practices for prevention of splenic rupture. Pediatric hepatologists working in selected tertiary academic centers in the United States, Canada, and the United Kingdom were contacted. Results: Hepatologists from 30 of 35 centers who met the inclusion criteria replied to the survey. Thirteen cases of splenic rupture were described of which 11 resulted from trauma. In the opinion of the practitioners, high-risk activities were football, hockey, and wrestling. Sixty-one percent recommended total restriction from high-risk activities. Seventy-four percent stated that platelet count had no effect on this decision and 61% advised a spleen guard for certain activities. Conclusions: Splenic rupture in patients with PHTN and splenomegaly seems to be rare. The reported splenic rupture cases were mostly related to falling (and not to participation in sports). There was general agreement among hepatologists about restricting high impact sports. There was variation in recommendations regarding the use of a spleen guard. The authors recommend use of spleen guards in children with splenomegaly from PHTN for physical activities with risk of fall or blunt abdominal trauma.

Original languageEnglish (US)
Pages (from-to)447-450
Number of pages4
JournalJournal of pediatric gastroenterology and nutrition
Volume66
Issue number3
DOIs
StatePublished - Mar 1 2018

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Keywords

  • hypersplenism
  • pediatric hepatologist
  • pediatric liver transplant
  • portal hypertension
  • spleen guard
  • splenic rupture
  • splenomegaly

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology

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