Partial splenic embolization as management of portal hypertension-related hypersplenism in pediatric patients.

INTRODUCTION

Endovascular partial splenic embolization (PSE) represents a therapeutic alternative for managing portal hypertension and hypersplenism that preserves splenic parenchyma and maintains immune function. This study aimed to describe the therapeutic response and safety profile of PSE in pediatric patients treated over an eleven-year period at a tertiary care center in Colombia.

METHODS

This was a descriptive, retrospective case series. We included 12 pediatric patients aged 8-15 years with hypersplenism secondary to portal hypertension who underwent PSE between 2012 and 2023 at our institution. Hematological parameters, endoscopic findings, and post-procedural complications were analyzed.

RESULTS

The median age was 13 years; nine patients (75%) had portal hypertension and hypersplenism due to portal vein thrombosis, and three (25%) due to hepatic fibrosis. The median percentage of embolized splenic parenchyma was 40% [IQR (25-60)]. Baseline platelet counts were 58,000 × 10⁹/L (50,250-67,000), and baseline leukocyte counts were 3,485 × 10⁹/L (2,728-4,090). Following PSE, statistically significant increases (delta) were observed in platelet count (median 235,000 × 10⁹/L, 95% CI 119,500-450,500; p = 0.0004) and white blood cell count (median 5,600 × 10⁹/L, 95% CI 2,883-8,925; p = 0.002). Eight patients underwent endoscopic follow-up; six demonstrated improvement in esophageal varices grade. Complications included transient abdominal pain and fever. No major adverse events, such as splenic abscess, infarction, rupture or hematoma, were recorded.

CONCLUSIONS

In our series, PSE demonstrated safety and efficacy in managing portal hypertension-related hypersplenism in pediatric patients, with significant improvements in hematological parameters and esophageal varices grade in most cases. PSE represents a valuable minimally invasive alternative to splenectomy, preserving splenic function while achieving therapeutic goals, even in patients requiring repeat interventions.