Splenic Rupture in Children With Portal Hypertension.

Introduction: Massive splenomegaly from portal hypertension (PHTN) in children raises the specter of splenic rupture, however the incidence, etiology, and risk of rupture has not been studied, nor have existing practices to reduce risk. We therefore performed an international survey in order 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 USA, Canada and the United Kingdom were contacted. Results: Hepatologists from 30 out 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. Conclusion: 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. (C) 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,

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