Scientific papers
Complications arising from splenic embolization after blunt splenic trauma

Presented at the 47th Annual Meeting of the Midwest Surgical Association, Mackinac Island, Michigan, August 15–18, 2004
https://doi.org/10.1016/j.amjsurg.2004.11.033Get rights and content

Abstract

Background

Nonoperative management (NOM) of splenic trauma is now the standard in stable trauma patients. Splenic artery embolization (SAE) is an increasingly used adjunct to NOM. We examined complications arising from SAE.

Methods

Patients admitted to a level I trauma center with splenic trauma over a 26-month period were identified. Management method, operative or nonoperative, was noted. SAE patients were analyzed in detail.

Results

There were 284 splenic trauma admissions. Ninety-three patients underwent operative management, and 191 received NOM. Fifteen patients (7.8%) underwent SAE. Embolization was proximal in 10, distal in 1, and combined in 4 patients. No NOM failures occurred. Major complications (27%) included splenic bleeding, splenic infarction, splenic abscess, and contrast-induced renal insufficiency. Minor complications of fever, pleural effusions, and coil migration occurred in 53% of patients. No relationship between SAE location and the presence of complications was noted.

Conclusions

SAE is an effective and safe procedure. Both major and minor complications can arise after SAE.

Section snippets

Methods

Trauma registry (TraumaBase, Clinical Data Management, Evergreen, Colorado) and medical record information of patients with splenic injuries admitted to Miami Valley Hospital (MVH), an ACS-verified adult and pediatric trauma center, between January 2000 and February 2004 were reviewed. Patients were grouped by management method of their splenic injury: operative or nonoperative. Individuals who underwent SAE were selected for detailed analysis. Age, sex, length of stay, associated injuries,

Results

During the 26-month period of review (January 2000 to February 2004), 284 patients were admitted to MVH with blunt splenic trauma. Ninety-three patients underwent operative management (82 splenectomies, 8 splenorrhaphies, and 3 resuscitative thoracotomies), and 191 underwent NOM.

Fifteen patients in the NOM group underwent SAE (7.8%). In this embolization group, there were 11 men and 4 women with ages ranging from 17 to 84 years (average 36.2). Injury was caused by motor vehicle crashes in 12

Comments

The earliest reports of splenic embolization in the literature were in the settings of hematologic disorders [10]. Typical indications cited in the literature include splenic artery aneurysms [11], portal hypertension with hypersplenism [12], and just before laparoscopic splenectomy [13]. Complications noted after SAE in nontrauma patients include splenic abscess, rupture of the spleen, pancreatitis, pneumonia, and septicemia [14], [15]. These patients undergoing SAE in nontraumatic settings

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