Management of Pseudoaneurysms Formed after Blunt Splenic Trauma in Children

Abstract

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.