Analysis of Pseudoaneurysms in Solid Organs after Blunt Abdominal Injury in Pediatric age group Treated at an Emergency Center

Abstract

Background: Pediatric trauma patients present unique clinical challenges such as different mechanisms of injury, physiological responses, and indications for operative versus nonoperative management compared to adults. Nonoperative management for blunt abdominal trauma is generally preferred in hemodynamically stable children and its outcomes are generally excellent. However, therapeutic strategy for pseudoaneurysms (PA) after solid organ injury (SOI) is controversial. Methods: Patients aged ≤ 15 years admitted to our hospital from April 2008 to March 2014 because of blunt abdominal trauma were enrolled in this study. The patients were divided into two groups: those complicated with PA (PA group) or without PA (non-PA group). Result: Among the 294 patients admitted with abdominal injury, 17 were enrolled in this study. No significant differences in patient characteristics, treatment course, or outcomes between the PA (n=4) and non-PA (n=13) groups were detected. All PA cases resolved spontaneously with close observation. Discussion: All PA cases were treated conservatively without the need for surgical procedures, including transarterial embolization, which is frequently required for adult PA cases after SOI; however, no consensus on transarterial embolization for pediatric cases has been reached, owing to its technical difficulty and potential complications. Our analysis suggested that PA after abdominal SOI can be successfully managed conservatively. Conclusion: Although the length of hospital stay and the period of restriction from full activity tended to be long, all our pediatric PA cases achieved spontaneous occlusion without any complications. Life-threatening complications such as delayed rupture of PA are rare and thus close observation is one of the best methods for treating hemodynamically stable children with PA caused by blunt abdominal trauma. We retrospectively reviewed the clinical cases of patients aged ≤15 years treated at our institution who had SOI after blunt abdominal trauma and analyzed the patient characteristics to clarify the necessity of TAE for PA after SOI. Patients and Methods Our hospital, Juntendo University, Urayasu Hospital, includes almost all possible medical facilities, including pediatrics, pediatric surgery, emergency physicians, and other types of specialized surgical support, including cardiovascular surgery, neurosurgery, and orthopedic surgery. Approximately 20,000 patients visit our Emergency Room and 5,000 patients are transported by ambulance to our facility each year. All surgeons and anesthesiologists are available throughout the 24 h each day; therefore, staffs are always available to perform emergency operations, even on pediatric patients. Our Emergency and Critical Care Center is similar to level 1 trauma center in USA. This is a retrospective study that was conducted at a single facility