Blunt Splenic Injuries in the Adolescent Trauma Population: The Role of Angiography and Embolization

The significance of pseudoaneurysms in the nonoperative management of pediatric blunt splenic trauma

“…A study by Schurr et al demonstrated SAP in 67% of adults who failed NOM [6]. This relationship between failed NOM and posttraumatic pseudoaneurysms in adults has lead to the practice of repeated imaging 24 to 48 hours after trauma and angiographic embolization of SAP if detected [7][8][9][10][11][12].The significance of posttraumatic SAP in the pediatric splenic trauma population is less well defined. Splenic pseudoaneurysm in this population is rare, and their presence alone has not been shown to predict delayed splenic bleeding or failure of NOM [1,3,5,[13][14][15].…”

The failure rate of nonoperative management in children with splenic or liver injury with contrast blush on computed tomography: a systematic review

“…This seems to suggest that the adjunction of AE leads to fewer failures. A critical note has to be made on this assumption because Mayglothling et al [14] described 44 adolescent patients (aged 13-17 years) with splenic injuries in whom AE seemed to be a valuable and safe treatment. However, it is questionable if these results also apply to younger patients in their childhood and to children with liver injuries.…”

“…This increased risk is supposed to be caused by the small size of the femoral artery, which may be difficult to cannulate, and the higher vasoreactivity in children, which makes accessing the splenic artery or deploying the coil more difficult. However, these are all theoretical risks, and the reviewed studies demonstrated no major complications and vascular injuries [14,16].…”

“…In total, 5 authors were contacted for additional information on the data. After reviewing the full-length text, another 11 studies were excluded for various reasons leaving nine eligible studies [9][10][11][12][13][14][15][16][17]. During quality assessment, one study was rated poor quality and 8 as moderate to good.…”

Contrast blush in pediatric blunt splenic trauma does not warrant the routine use of angiography and embolization

“…Thus, adolescents, those with associated closed head injury, and children being treated at adult trauma centers are more likely to undergo an AE procedure. 18 24,25 However, CB was only seen in a small number of patients in both series making it difficult to draw any conclusions. In our current series, CB was seen in 17.4% of cases and was associated with higher grades of injury.…”