Splenic artery embolisation in the non-operative management of blunt splenic trauma in adults

Richard J Cormack,Stefan Przybojewski,Jason K Wong,Mollie C.M Ferris

doi:10.4102/sajr.v20i1.1014

Abstract

Background: The purpose of this study was to evaluate the splenic salvage rate with angioembolisation in the non-operative management (NOM) of blunt splenic injury.Methods: We conducted a retrospective analysis of patients presenting to our Level I trauma centre with computed tomography (CT)-confirmed splenic injury following blunt trauma and in whom angioembolisation was utilised in the algorithm of NOM. Data review included CT and angiography findings, embolisation technique and patient outcomes.Results: Between January 2005 and April 2010, 60 patients with splenic injury following blunt trauma underwent NOM, which included splenic artery embolisation (SAE). All patients included in the study required a preadmission. CT scan was used to document the American Association for the Surgery of Trauma (AAST) grade of splenic injury. The average injury grade was 3.0. The non-operative splenic salvage rate following SAE was 96.7% with statistically similar salvage rates achieved for grades II to IV injuries. The quantity of haemoperitoneum and the presence of a splenic vascular injury did not significantly affect the splenic salvage rate. The overall complication rate was 27%, of which 15% were minor and 13% were major.Conclusion: SAE is a safe and effective treatment strategy in the NOM of blunt splenic injury. The quantity of haemoperitoneum, the presence of vascular injury and embolisation technique did not significantly affect the splenic salvage rate.

Highlights

At our institution, haemodynamically stable patients with blunt splenic injury are managed nonoperatively with the goal of preserving splenic function by avoiding splenectomy
computed tomography (CT) can accurately assess the severity of splenic injury using the Association for the Surgery of Trauma (AAST) grade, estimate the volume of haemoperitoneum, characterise vascular injuries and help direct appropriate therapy.[3,8]
Forty-three patients presented with a significant haemoperitoneum and 31 patients had evidence of a vascular injury (Table 1)

Summary

Introduction

Haemodynamically stable patients with blunt splenic injury are managed nonoperatively with the goal of preserving splenic function by avoiding splenectomy. Non-operative management (NOM) generally includes bed rest, limited oral intake and close clinical and biochemical observation. Patients with suspected splenic trauma who are candidates for NOM should have a contrastenhanced computed tomography (CT) scan to evaluate and grade the extent of injury.[4] CT can accurately assess the severity of splenic injury using the AAST grade, estimate the volume of haemoperitoneum, characterise vascular injuries and help direct appropriate therapy.[3,8]. The purpose of this study was to evaluate the splenic salvage rate with angioembolisation in the non-operative management (NOM) of blunt splenic injury

Objectives

Results

Conclusion