Abstract
Purpose: We have been actively carrying out transcatheter arterial embolization (TAE) for children suffering from traumatic splenic injury associated with extravasation and pseudoaneurysms. Many cases could be successfully managed with conservative treatment with TAE.
Methods: From January 1996 to December 2011, 27 cases aged less than 15 years were transferred to the emergency room in our institute because of traumatic splenic injury. They consisted of 23 boys and 4 girls; and their average age was 8.4 years old (age range: 1 to 13 years). Nineteen cases had only splenic injury, and 8 cases were associated with multiple organs injury. Their clinical data were investigated.
Results: According to the Surgery of Trauma 2008 of the Japanese Association, the severity was categorized as Ia (n = 1), Ib (n = 2), II (n = 3), IIIa (n = 5), and IIIb (n = 16). Only 1 (IIIb) needed laparotomy, 11 (IIIa: 4, IIIb: 7) underwent angiography, and 5 (extravasation: 3, pseudoaneurysm: 2) cases were treated with TAE. In all cases, bleeding was successfully controlled and well managed conservatively, except for the laparotomy case. Cases with only splenic injury were intervened with either TAE (n = 4) or conservative treatment (n = 15): the Hb values were 10.5 ± 3.1 and 11.7 ± 1.4 g/dl (p = 0.244), and the revised trauma scores were 7.58 ± 0.5 and 7.75 ± 0.3 (p = 0.350) in the former and latter during hospitalization, respectively. However, the injury severity scores of the former (14.0 ± 3.8) was significantly (p = 0.004) higher than that of the latter (7.93 ± 2.0).
Conclusion: Even in cases having splenic injuries with extravasation and pseudoaneurysms, TAE provided bleeding control and favorably treated the patients without surgery.
