The Investigation of Posttraumatic Pseudoaneurysms in Patients Treated with Nonoperative Management for Blunt Abdominal Solid Organ Injuries

Abstract

BackgroundPosttraumatic pseudoaneurysms (PAs) have been recognized as the cause of delayed hemorrhage complicated with nonoperative management (NOM), although the need for intervention in patients with small-sized PAs and the relationship between the occurrence of PAs and bed-rest has been also unclear.ObjectivesThe purpose of this study was to investigate the clinical history of small-sized PAs (less than 10 mm in diameter) which occurred in abdominal solid organs, and to analyze the relationship between the occurrence of PAs and early mobilization from bed.MethodsSixty-two patients who were successfully managed with NOM were investigated. Mobilization within three days post-injury was defined as “early mobilization” and bed-rest lasting over three days was defined as “late mobilization.” A comparison of the clinical factors, including the duration of bed-rest between patients with and without PAs detected by follow-up CT was performed. Furthermore, a multiple logistic regression model analysis on the occurrence of PAs was performed.ResultsPAs were detected in 7 of the 62 patients. The One patient with PAs measuring larger than 10 mm received trans-arterial embolization, and the remaining six patients with PAs smaller than 10 mm were managed conservatively. Consequently, no delayed hemorrhage occurred, and the PAs spontaneously disappeared in all of the six patients managed without intervention. The multiple regression model analysis revealed that early mobilization was not a significant factor predicting new-onset PAs.ConclusionsSmall PAs can be expected to disappear spontaneously. Moreover, early mobilization is not a significant risk factor for the occurrence of PAs.

Traumatic Intraparenchymal Pseudoaneurysm on Initial Imaging Predicts Injury Progression in Patients with Nonoperative Major Blunt Liver Injury

“…In the absence of long-term data, it is prudent to treat them. This is consistent with prior studies that demonstrate spontaneous resolution of most hepatic post traumatic pseudoaneurysms [19].…”

Outcomes and management of delayed complication after severe blunt liver injury

“…Because our cases had a diameter of < 10 mm and were surrounded by the liver parenchyma within the intrahepatic parenchyma, we chose to treat conservatively. Kittaka et al reported that post-traumatic pseudoaneurysm in solid organs, such as the liver, spleen, and kidney, may disappear spontaneously when the diameter is < 10 mm [ 21 ]. Even if the HAPs rupture, it might be possible that hemostasis could still be obtained by internal pressure.…”

Management of a delayed, post-traumatic rupture of splenic artery pseudoaneurysm in a patient with life threatening co-morbidities: A treatment challenge

“…Nonetheless, the rates of delayed hemorrhage though rare, occur in 0–3.9% of patients. It is a life-threatening complication of NOM and often requires an emergency laparotomy and needs to be judiciously undertaken with explained risks [ 11 ].…”