Splenic abscess is a rare clinical condition with a reported incidence of 0.14 % to 0.70 % in various autopsy series. Primary tuberculosis of the spleen as a cause of splenic abscess is even rarer, especially in the antitubercular era. Infants and children have a higher predisposition to extra-pulmonary tuberculosis than adults and tend to develop severe extra-pulmonary disease such as miliary tuberculosis and meningitis. The diagnosis of tuberculosis in infants and children can be difficult because of nonspecific symptoms and clinical findings. Computed tomography establishes the diagnosis of splenic abscess and demonstrates the number and location of abscesses. Splenectomy is the standard of care in most clinical setting. We present a 4-year-old girl who had multiple tuberculosis splenic abscesses and was treated successfully with splenectomy.

Solid pseudopapillary tumor (SPT) of the pancreas occurs most frequently in the second or third decades of life, and is prevalent in females. Unlike other pancreatic malignancy, SPT usually has a low malignancy potential. This study reviews our clinical experience and surgical treatment of pancreatic SPT. Admission records and follow-up data were analyzed retrospectively for the period between January 1996 and January 2003. Five patients with a pancreatic mass were operated upon and SPT was confirmed by pathology in each case. The male to female ratio was 1 : 4. The median age was 13.8 years. Findings were vague upper abdominal pain (n=5, 100 %) and an abdominal palpable mass (n=3, 60 %). The median tumor diameter was 6.8cm and the locations were 2 in the pancreatic head (40 %) and 3 in the pancreatic tail (60 %). Extra-pancreatic invasion or distant metastasis was not found at the initial operation in all five cases. A pyloruspreserving pancreaticoduodenectomy (n=1) and a mass enucleation (n=1) were performed in two patients of pancreatic head tumors. For three cases of tumors in pancreatic tail, distal pancreatectomy (n=2) and combined distal pancreatectomy and splenectomy (n=1) were performed. The median follow-up period was 60 months(12-117month). During the follow-up period, there was no local recurrence, nor distant metastasis. Postoperative adjuvant chemotherapy or radiotherapy was not carried out. All five children were alive during the follow up period without any evidence of disease relapse. SPT of the pancreas in childhood has good prognosis and surgical resection of the tumor is usually curative.

The laparoscopic splenectomy (LS) became popular over the last 10 years. The advantage of LS over open splenectomy (OS) includes short hospital stay, improved cosmesis, less development of postoperative intestinal ileus, and less analgesics required. The purpose of this study is to evaluate the outcome of LS at Asan Medical Center from January 1999 to January 2003. The records of 14 consequent children who underwent splenectomy were reviewed retrospectively. Patients characteristics, morbidity, mortality, operative time, blood loss, and hospital stay were analyzed., Seven patients age 5 to 15 years underwent LS under the indications: idiopathic thrombocytic purpura (ITP, n=3), hereditary spherocytosis (n=3), and myelodysplastic syndrome (n=1). Seven patients, age 7 to 16 years, underwent OS during the same period for ITP (n=7). Median operative time was 120 minutes (80 to 170 mins.) in OS, and 270 minutes (110 to 480 mins.) in LS (p<0.05). Median length of hospital stay was 6 days (3 to 8) in OS, and 4 days (3 to 6) in LS (p>0.05). Median splenic length was 12.0 cm (9.2 to 18.0) in OS, 14.0 cm (10.0 to 19.5) (p>0.05). Accessory spleens were identified in 3 of 7 LS and 1 of 7 OS cases. In the LS group, there was no conversion to open surgery. Two patients in LS required blood transfusion postoperatively. LS in children can be performed as effectively and safely as OS.

Splenic cysts are uncommon and classified as either primary(true) or secondary(pseudo-) depending on the presence or absence of a true epithelial lining. True cysts (epidermoid cyst) of the spleen are very rare. Three cases of splenic cysts in childhood were treated at the Yeungnam University Hospital in the last eleven years(1989 - 1999). Two of patients were girls. The ages at diagnosis were 7, 12 and 15 years. Abdominal ultrasonography and computerized tomography were utilized for the diagnosis. Radionuclide scanning was performed in one patient. Surgical resection(one partial splenectomy and two total splenectomies) was performed. The sizes of cysts were 4, 6.5 and gem in maximum demension.

Pediatric laparoscopic splenectomy has gained increasing acceptance in the surgical management of a variety of splenic disorders, in particular hematologic diseases. We report our experience with 16 patients who underwent this procedure because of hematologic disorders during the past 3 and a half years at the Department of Surgery, St. Mary's Hospital, Catholic University Medical College. The mean age was 10 years (Range 6-16 years) and the mean spleen weight was 210 gm (Range 85-500 gm). The indications for splenectomy were hereditary spherocytosis (6 cases), idiopatic thrombocytopenic purpura (8 cases), autoimmune hemolytic anemia (1 case), and idiopatic splenomegaly (1 case). All splenectomies were performed safely with mean estimate blood loss of 233 ml. Mean operative time and mean postoperative hospital stay was 157 min and 4.5 days. Respectively postoperative pain medication was needed in 3 case, just one injection in immediate postoperative period. Diet was started on posterative second day or third day. In conclusions, Laparoscopic splenectomy in pediatric patients surely is a safe procedure, offering better cosmesis, much less pain, and shorter hospital stay with lower post operative mobidity.

Three cases of laparoscopic splenectomy for hereditary spherocytosis are reported. The average operation time was 100 minutes. This was longer than traditional open splenectomy for the same entity( 63 minutes). Average hospitalization period was 3 days. This was shorter than the hospitalization period for the traditional group(6.2 days).