WE7.3 Splenic abscess formation following selective splenic embolisation for a traumatic splenic injury and its subsequent conservative management

Abstract

Abstract Splenic injuries are the most commonly injured organ following blunt abdominal trauma1. Current standard of care for a haemodynamically stable patient is non operative management (NOM). Although selective arterial embolization (SAE) is a useful adjunct in NOM, the complications from this intervention and subsequent management are poorly detailed in the literature4. This report describes the development of a splenic abscess post SAE for a traumatic splenic injury. A 50-year-old haemodynamically stable blunt trauma patient with a grade IV splenic laceration and concomitant rib fractures was treated conservatively with SAE. Post embolization the patient's haemoglobin and inflammatory markers remained stable and he self-discharged on day 5. He returned 3 days later with abdominal pain, a repeat CT demonstrated a left sided pleural effusion and his subcapsular haematoma had increased in size, but inflammatory markers and haemoglobin remained stable. He was admitted for monitoring. During admission he reported increasing abdominal pain and his inflammatory markers had drastically worsened, CRP 340 (60) and WBC 14 (7). A repeat CT demonstrated a splenic abscess and worsening of his pleural effusion. He was taken for IR drainage, which led to an immediate improvement of his pain and resolution of his pleural effusion after 2-weeks. This case report of a post SAE abscess following a splenic injury is unique because the patient did not demonstrate typical signs of infection. It was serial monitoring of bloods and early repeat cross sectional imaging that facilitated a timely diagnosis, allowing us to avoid a splenectomy, thus preserving splenic function.