C. Morrison1, J. C. Lee1, K. Rittenhouse1, M. Kauffman1, B. W. Gross1, F. Rogers1 1Lancaster General Hospital,Trauma,Lancaster, PA, USA
Introduction: The use of angiography has been associated with lower rates of failed non-operative splenic injury management. To date, there is an unclear rate of splenic artery pseudoaneurysms in these patients. We sought to determine the rate of asymptomatic vascular injury in patients with splenic injury managed without operation or angiographic embolization and the outcomes of patients managed with and without re-imaging.
Methods: Patients undergoing splenic injury management with and without surgical intervention or angiographic embolization from 2011 to 2014 were queried from the trauma registry of a Pennsylvania-verified, level II trauma center. Patients were routinely re-imaged as part of our practice. We excluded penetrating trauma and immediate operative intervention was excluded from our analysis. Splenic injuries were classified using American Association for the Surgery of Trauma (AAST) guidelines by attending radiologist or senior trauma surgeon. Rates of repeat imaging, subsequent embolization and re-bleeding, and diagnosis of pseudoaneurysm were determined.
Results: A total of 132 patients met the inclusion criteria, of which 72.7% were managed non-operatively (N=96) and 27.3% operatively (N=36). Within the non-operative patient population, eight pseudoaneurysms were found; three on initial scans and five on repeat scans. Rates of re-imaging were 39.58% (N=38); angioembolization, 22.92% (N=22); and readmission, 10.41% (N=10); in patients managed non-operatively. Three large (>3cm) pseudoaneurysms were observed in the repeat CT scans.
Conclusion: Splenic injuries are typically managed non-operatively without serious complications. Patients with splenic injuries (> Grade 3) managed non-operatively should have repeat imaging within 48 hours to rule out the possibility of pseudoaneurysms, regardless of worsening symptoms or decreasing hemoglobin. Patients with pseudoaneurysms may be amenable to angioembolization.