The significance of pseudoaneurysms in the nonoperative management of pediatric blunt splenic trauma

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• 作者：Kathryn Martin^a ; Lisa VanHouwelingen^a ; Andreana Bü ; tter ; ^a ; ^{andreana.butter@lhsc.on.ca"" rel=""nofollow}
• 关键词：Pediatric ; Blunt splenic trauma ; Pseudoaneurysm ; Nonoperative management
• 刊名：Journal of Pediatric Surgery
• 出版年：2011
• 出版时间：May 2011
• 年：2011
• 卷：46
• 期：5
• 页码：933-937
• 全文大小：171 K

文摘

Purpose

Nonoperative management is the standard of care for hemodynamically stable pediatric and adult blunt splenic injuries. In adults, most centers follow a well-defined protocol involving repeated imaging at 24 to 48 hours, with embolization of splenic pseudoaneurysms (SAPs). In children, the significance of radiologically detected SAP has yet to be clarified.

Methods

A systematic review of the medical literature was conducted to analyze the outcomes of documented posttraumatic SAP in the pediatric population.

Results

Sixteen articles, including 1 prospective study, 4 retrospective reviews, and 11 case reports were reviewed. Forty-five SAPs were reported. Ninety-six percent of children were reported as stable. Yet, 82 % underwent splenectomy, splenorrhaphy, or embolization. The fear of delayed complications owing to SAP was often cited as the reason for intervention in otherwise stable children. Only one child with a documented pseudoaneurysm experienced a delayed splenic rupture while under observation. No deaths were reported.

Conclusions

There is no evidence to support or dispute the routine use of follow-up imaging and embolization of posttraumatic SAP in the pediatric population. At present, the decision to treat SAP in stable children is at the discretion of the treating physician. A prospective study is needed to clarify this issue.