Association between contrast extravasation on computed tomography scans and pseudoaneurysm formation in pediatric blunt splenic and hepatic injury: A multi-institutional observational study

Katsura, Morihiro; Fukuma, Shingo; Kuriyama, Akira; Takada, Tadaaki; Ueda, Yasuhiro; Asano, Shima; Kondo, Yutaka; Ie, Masafumi; Matsushima, Kazuhide; Murakami, Takahiro; Fukuzato, Yoshimitsu; Osaki, Nobuhiro; Mototake, Hidemitsu; Fukuhara, Shunichi

doi:10.1016/j.jpedsurg.2019.07.005

Cited by 15 publications

(25 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Regarding the management of pseudoaneurysms associated with pediatric blunt splenic trauma, the incidence rate and management strategies are unknown because of the small number of cases. The incidence rate is reported to range from 2% to 15% 9,10) , which greatly differs from the result of our study (31.6%). Our result may have been affected by the fact that our hospital is a tertiary emergency medical center that predominantly treats severe patients (type III injury accounting for 73.7% of cases).…”

Section: Figure 2 Treatment Algorithm For Pediatric Solid Organ Injur...contrasting

confidence: 99%

“…Conversely, TAE is recommended for adult patients with pseudoaneurysms who have stable hemodynamics and an Abbreviated Injury Scale score of 2 to 3 (GRADE system: 2A) 13) . Pseudoaneurysm is considered to often become thrombosed 9,10) , however, our policy for the treatment of pseudoaneurysm is to actively perform TAE immediately after the detection of pseudoaneurysm regardless of its size because we experienced cases of delayed hemorrhage due to pseudoaneurysm such as those described above.…”

Section: Figure 2 Treatment Algorithm For Pediatric Solid Organ Injur...mentioning

confidence: 99%

See 1 more Smart Citation

Management of Pseudoaneurysms Formed after Blunt Splenic Trauma in Children

Furuta

Nagae

Ohyama

et al. 2021

J St. Marianna Univ

View full text Add to dashboard Cite

Blunt splenic trauma is primarily treated conservatively. Delayed hemorrhage is sporadically reported as a complication. We present our experience of blunt splenic trauma and discuss the management of associated pseudoaneurysms.[Methods] Nineteen pediatric cases of blunt splenic trauma managed at our facility from 2005 to 2018 were examined. Age at the time of trauma; disease type; presence or absence of extravascular leakage, pseudoaneurysms, and multiple trauma; treatment; and outcomes were retrospectively collected from the medical records.[Results] The median age at the time of trauma was 8.0 (4-14) years. Overall, two, three, one, and 13 patients had type I, II, IIIa, and IIIb disease, respectively. Multiple trauma and extravascular leakage were observed in four patients (21.1%). Six patients (31.6%) developed pseudoaneurysms. The treatments included nonoperative management (NOM) (14 patients [74%]), transarterial embolization (TAE) (four patients [21%]), and surgery (one patient [5%]). Regarding complications, one patient with pseudoaneurysm who underwent NOM developed delayed hemorrhage.[Conclusion] The incidence of pseudoaneurysm due to splenic trauma is higher than that previously reported. We also observed delayed hemorrhage as a complication. We, therefore, emphasized the risk of rupture during conservative treatment and decided to perform TAE in principle for pseudoaneurysm at our hospital.

show abstract

Section: Figure 2 Treatment Algorithm For Pediatric Solid Organ Injur...contrasting

confidence: 99%

Section: Figure 2 Treatment Algorithm For Pediatric Solid Organ Injur...mentioning

confidence: 99%

Management of Pseudoaneurysms Formed after Blunt Splenic Trauma in Children

Furuta

Nagae

Ohyama

et al. 2021

J St. Marianna Univ

View full text Add to dashboard Cite

show abstract

“…Some authors, however, identify the presence of active contrast extravasation as an independent predictor for pseudoaneurysm (PSA) formation in children, regardless of injury grade. This suggests a thorough follow-up during NOM of these patients, so to obtain an early identification and angiographic treatment of PSA [62].…”

Section: Diagnosismentioning

confidence: 93%

Liver trauma: WSES 2020 guidelines

et al. 2020

View full text Add to dashboard Cite

Liver injuries represent one of the most frequent life-threatening injuries in trauma patients. In determining the optimal management strategy, the anatomic injury, the hemodynamic status, and the associated injuries should be taken into consideration. Liver trauma approach may require non-operative or operative management with the intent to restore the homeostasis and the normal physiology. The management of liver trauma should be multidisciplinary including trauma surgeons, interventional radiologists, and emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) liver trauma management guidelines.

show abstract

“…In pediatrics, injury grade according to the AAST classification is seemingly not correlated with PA formation (10,11) . In our series, no relationship between injury grade and PA formation was found, probably as a result of most traumas being grade III or IV.…”

Section: Discussionmentioning

confidence: 99%

“…Since conservative management has demonstrated to be a successful approach, various authors have called into question the need for control studies, primarily due to the low incidence of late complications, and also to ionizing radiation exposure as a result of CT-scan (4,12,13) . However, various groups recently suggested conducting control studies to rule out complications, including PA formation (1,5,10,11) . As previously stated, in our institution, control studies are carried out in all traumas ≥ grade III.…”

Section: Discussionmentioning

confidence: 99%