The first experience with non-operative treatment of hypersplenism in children with portal hypertension

The register of Latvian children with portal hypertension (PH) includes 34 patients from 2 to 16 years old. In 26 children the PH is caused by a prehepatic obstruction. The most widespread symptoms of PH are variceal bleeding and hypersplenism. The traditional management of hypersplenism has been splenectomy. We have used partial splenic embolization (PSE) as an alternative to splenectomy. From 1998 to 2000 we carried out PSE in 8 patients with PH. A percutaneous femoral artery approach to the splenic artery was used to deliver microspheres with a diameter of 0.3 mm into the spleen, minimizing blood circulation to the organ by 60-70%. In 7 patients symptoms of hypersplenism disappeared and blood tests returned to normal status. In one patient we carried out PSE twice. In one case PSE was not successful and the patient underwent partial resection. Abdominal pain and subfebrility were observed on average 2 weeks after PSE. In 7 patients the 4-20 months follow-up period demonstrated the efficiency of the non-operative hypersplenism management method. We conclude that PSE is the method of choice to treat hypersplenism.