Spontaneous occlusion of post-traumatic splenic pseudoaneurysm: report of two cases in children

Abstract

Conservative therapy for splenic injuries is widely advocated. The advantages of conservative therapy for splenic injuries include the preservation of splenic immune function, prevention of overwhelming post-splenectomy sepsis, and avoidance of laparotomy and its associated early and late complications. Pseudoaneurysms of the splenic artery branch are encountered because of the prevalence of conservative management and widespread use of imaging techniques in the follow-up of these cases. We report two cases of post-traumatic splenic pseudoaneurysm in children which thrombosed spontaneously, one during the diagnostic angiogram examination and another on follow-up studies.

Spontaneous Occlusion of Splenic and Renal Pseudoaneurysm After Blunt Abdominal Trauma: A Case Report and Literature Review

“…In almost all reports of the NOM for post-traumatic SPA, angiography and embolization have been performed as soon as the SPA was detected (7,14 -16). However, some authors report the spontaneous occlusion of SPA after blunt abdominal trauma (17)(18)(19)(20). In Table 1, we summarize previous reports along with our case, where we confirmed the spontaneous occlusion of pseudoaneurysms in solid organs of a patient who we treated conservatively.…”

“…Renal pseudoaneurysm (RPA) is a very rare complication after blunt trauma, and the preferred method of treatment for this type of vessel injury in solid organs after blunt trauma is by NOM, especially by angiography and embolization (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). However, there are no guidelines stating when these treatments should be performed, and in a small number of reported cases, these injuries have been treated conservatively (17)(18)(19)(20). To avoid complications that can arise as a result of angiography and embolization in traumatized patients, especially children, we need to determine when this type of intervention is required (21,22).…”

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

“…One AVF was observed with serial ultrasounds and resolved without complication [21]. The remaining 4 AVF underwent intervention: 3 had uncomplicated embolizations and 1 underwent splenectomy [7,17,24,26]. Two patients were found to have multiple pseudoaneurysms [18,19].…”

“…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].…”

“…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].…”