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

Inoue, Yoshihisa; Ikegawa, Hitoshi; Ukai, Isao; Yoshiya, Kazuhisa; Sumi, Yasuo; Ogura, Hiroshi; Kuwagata, Yasuyuki; Tanaka, Hiroshi; Shimazu, Takeshi; Sugimoto, Hisashi

doi:10.1016/j.jemermed.2007.07.023

Cited by 13 publications

(10 citation statements)

References 38 publications

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“…These SPAs were associated with Grade III and IV injuries and were spontaneously occluded in 7 patients (70%) within 12 days. Inoue et al 7 reviewed eight previously reported spontaneous occlusions of SPAs in adults and children, but the incidence of SPA with spontaneous occlusion was not clear. In the present study, we showed a high rate of spontaneous occlusion of delayed SPA.…”

Section: Discussionmentioning

confidence: 99%

“…6 The incidence and the timing of SPA formation, however, have not been thoroughly investigated, and the timing of follow-up CT is controversial. Furthermore, there are few reports on the natural course of SPA after splenic injury with NOM, 7 and the incidence of spontaneous occlusion of SPA has not been clarified. Therefore, the objective of this study was to clarify the incidence and timing of both the delayed formation and spontaneous resolution of SPA following splenic injuries treated with NOM in several trauma centers in Japan.…”

mentioning

confidence: 99%

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Delayed formation of splenic pseudoaneurysm following nonoperative management in blunt splenic injury

Muroya

Ogura

Shimizu

et al. 2013

Journal of Trauma and Acute Care Surgery

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Delayed formation of splenic pseudoaneurysm following nonoperative management in blunt splenic injury

Muroya

Ogura

Shimizu

et al. 2013

Journal of Trauma and Acute Care Surgery

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“…It may be related to catheter-induced vasospasm and spontaneous thrombosis within the aneurysmal lumen. [30][31][32] Endovascular treatment has been gradually accepted as the first choice for hemorrhage from pseudoaneurysm, which includes embolization and stent-graft placement. [11][12][13]18 Compared with surgical intervention, endovascular intervention was associated with a lower mortality rate in our series.…”

Section: Discussionmentioning

confidence: 99%

Therapeutic Management of Hemorrhage from Visceral Artery Pseudoaneurysms after Pancreatic Surgery

Ding

Zhu

et al. 2011

Journal of Gastrointestinal Surgery

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“…The use of TAE for PA in pediatric patients with blunt abdominal injury is controversial. Based on literature (Inoue et al), the longest duration for observing delayed rupture of PA was 3 weeks after the injury, and spontaneous occlusion was seen in cases of PA with a size below 10 mm [12]. Therefore, in case of confirmed PA on enhanced CT that do not occlude spontaneously until 3 weeks, with confirmed, increase of more than 10 mm in size, Table 2 presents the clinical characteristics of all 17 pediatric abdominal trauma patients with SOI.…”

Section: Clinical Characteristics Of Pediatric Abdominal Injurymentioning

confidence: 99%

“…In adult cases, transarterial embolization (TAE) is often performed immediately after PA is detected [10]. In children, this therapeutic strategy for PA after SOI is controversial due to the danger of rupture and difficulty of TAE [8,[11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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

Ishihara¹,

Inoué²,

Nishiyama³

et al. 2016

Emerg Med

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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

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

Cited by 13 publications

References 38 publications

Delayed formation of splenic pseudoaneurysm following nonoperative management in blunt splenic injury

Delayed formation of splenic pseudoaneurysm following nonoperative management in blunt splenic injury

Therapeutic Management of Hemorrhage from Visceral Artery Pseudoaneurysms after Pancreatic Surgery

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

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