Do not remove injured spleen after child accidents

Do not remove injured spleen after child accidents

12/10/2014

For example, if the spleen is injured in children after an accident, it should not be removed. The immune organ should be preserved as it protects against infections for life. However, health insurance companies pay for a removal more than for the treatment.

In 8,000 people, the spleen was removed last year
Although the spleen fulfills various functions in the human body, it is not an essential organ. Spleen pain can be due to a variety of causes. For example, an enlarged spleen, a splenic infarction or spleen cancer are eligible for this. In some cases, physicians and patients decide to surgically remove the organ. However, this usually happens due to an injury, such as a splenic rupture. Around 8,000 people had their spleens removed from the operation table in Germany last year, including 300 children and adolescents, according to the German Society for Pediatric Surgery (DGKCH).

Spleen for the body's defense
Especially young people need their spleen for the body's defense. Therefore pediatric surgeons try to save an injured spleen instead of removing the immune organ. Accidents during riding, downhill mountain biking or in traffic, but also a fall from the changing table cause up to 15 percent serious injury to the abdominal organs of children. In one third of the cases, the spleen is affected. Since a splenic rupture can lead to shock and death from bleeding, doctors in adults usually remove the injured organ. However, removing the immune system for patients means that they are more susceptible to infection for life, to the point of risk of fatal blood poisoning. „This risk is significantly increased, especially in childhood, but also among adolescents“, explained Professor med. Bernd Tillig, President of DGKCH.

Change in pediatric surgery
In pediatric surgery, the findings on the spleen as an important organ in recent years have caused a change: „In children and adolescents we try very hard to maintain the organ and to avoid taking it“, says Tillig, the chief physician of pediatric surgery at the Vivantes Hospital in Berlin. Progress in diagnostics and therapy also played a role in this development. It is now possible to locate, assess and treat a wound in the abdomen.

To treat spleen injuries in 98 percent of cases without surgery
Splenic injury is now successfully treated without surgery in about 98 percent of cases. „However, the condition is that the bleeding is manageable and not primarily life-threatening. In addition, the clinics must have the appropriate pediatric surgical expertise, specialized physicians and the required technical equipment.“ Often modern interventional, radiological therapy methods help in which the doctor introduces small catheters via a puncture into the blood vessels and stops the bleeding in the spleen by targeted embolization.

Cashiers pay for removal more than for treatment
However, the non-surgical approach is often more time-consuming than the rapid removal of the spleen. „We have to closely monitor our ICU patients for hours to days using state-of-the-art technology. Because it is ultimately about life and death in severe spleen injuries, we are available around the clock to stop the bleeding if necessary still operatively.“ Tillig went on to explain that pediatric surgery sometimes means not specifically to operate. He gives to consider: „From a business point of view, however, this is a loss business.“ This is because the health insurances paid more money as part of their lump sum payments for removal of a salary than for a hospital stay in which the organ would be saved. Here must still be readjusted, the expert demands. (Ad)