Overwhelming postsplenectomy sepsis in childhood.

Three hundred ninety-three splenectomies were performed within the Charity Hospital system during the decade from 1969 through 1979. This number included 56 operations in children under 16 years of age, which formed the basis of this report of the risk of infection in young splenectomized patients and provided guidelines for the role of splenectomy under emergency and elective conditions. Eight episodes of serious infection were documented in four patients. There was only one case of overwhelming postsplenectomy infection which resulted in death, for a mortality rate of 1.8 percent (1 of 56 children) for death due to overwhelming postsplenectomy sepsis. It is emphasized, however, that the development of serious postsplenectomy sepsis in our series resulted in a 25 percent mortality rate. The risk of postsplenectomy sepsis is much greater in those individuals who are immunologically compromised, such as those who undergo staging splenectomy for Hodgkin's disease. If splenectomy is indicated for a hematologic disorder, it is wise to defer operation for as long as possible, especially if the acute episodes are self-limiting or mild. Rather than the promiscuous use of polyvalent serum and antibiotic therapy after splenectomy in children, it is recommended that parents be advised to bring the child to the hospital anytime an illness or fever develops that might require an immediate loading dose of an appropriate antibiotic. The role of subtotal splenectomy or hemisplenectomy merits consideration in staging Hodgkin's disease. Preoperative study of certain immunologic parameters may provide guidelines as to the proportion of individuals who may be vulnerable to overwhelming sepsis after splenectomy.