Low morbidity profile of spleen mesh wrapping in children

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 non-surgically.