C Frumiento1, K Sartorelli, D Vane. 1. University of Vermont, College of Medicine, Department of Surgery, Burlington 05405, USA.
Abstract
BACKGROUND/ PURPOSE: Delayed complications (hemorrhages, abscesses, and pseudo-aneurysms) of nonoperative management (NOM) in pediatric spleen injuries are rare but reportedly result in failure of NOM. This study was undertaken to elucidate the rate of delayed complications and their impact on NOM of splenic injuries. METHODS: Forty children who underwent NOM of splenic injuries over 5 years were reviewed for complications and success of NOM. All injuries were diagnosed and graded by computed tomography (CT) scans. Follow-up imaging studies were obtained in all children 6 to 12 weeks postinjury; additional scans also were obtained when clinically indicated. RESULTS: NOM was successful in all children, but 3 (7.5%) had delayed complications. A 3 year old with a grade III splenic injury and a distal pancreatic transection, and a 13 year old with a grade IV injury had pseudoaneurysms, which were noted on follow-up CT scan (14 days postinjury). The pseudoaneurysms were treated expectantly and resolved spontaneously. A 16 year old (grade IV injury) had a splenic abscess 8 days postinjury that was drained percutaneously with CT guidance. CONCLUSIONS: Development of delayed complications may not preclude successful NOM of pediatric spleen injuries. Splenic artery pseudoaneurysms in children appear to resolve spontaneously without intervention.
BACKGROUND/ PURPOSE: Delayed complications (hemorrhages, abscesses, and pseudo-aneurysms) of nonoperative management (NOM) in pediatric spleen injuries are rare but reportedly result in failure of NOM. This study was undertaken to elucidate the rate of delayed complications and their impact on NOM of splenic injuries. METHODS: Forty children who underwent NOM of splenic injuries over 5 years were reviewed for complications and success of NOM. All injuries were diagnosed and graded by computed tomography (CT) scans. Follow-up imaging studies were obtained in all children 6 to 12 weeks postinjury; additional scans also were obtained when clinically indicated. RESULTS: NOM was successful in all children, but 3 (7.5%) had delayed complications. A 3 year old with a grade III splenic injury and a distal pancreatic transection, and a 13 year old with a grade IV injury had pseudoaneurysms, which were noted on follow-up CT scan (14 days postinjury). The pseudoaneurysms were treated expectantly and resolved spontaneously. A 16 year old (grade IV injury) had a splenic abscess 8 days postinjury that was drained percutaneously with CT guidance. CONCLUSIONS: Development of delayed complications may not preclude successful NOM of pediatric spleen injuries. Splenic artery pseudoaneurysms in children appear to resolve spontaneously without intervention.
Authors: Catherine M Dickinson; Roberto J Vidri; Alexis D Smith; Hale E Wills; Francois I Luks Journal: Pediatr Surg Int Date: 2018-09-07 Impact factor: 1.827
Authors: Federico Coccolini; Giulia Montori; Fausto Catena; Yoram Kluger; Walter Biffl; Ernest E Moore; Viktor Reva; Camilla Bing; Miklosh Bala; Paola Fugazzola; Hany Bahouth; Ingo Marzi; George Velmahos; Rao Ivatury; Kjetil Soreide; Tal Horer; Richard Ten Broek; Bruno M Pereira; Gustavo P Fraga; Kenji Inaba; Joseph Kashuk; Neil Parry; Peter T Masiakos; Konstantinos S Mylonas; Andrew Kirkpatrick; Fikri Abu-Zidan; Carlos Augusto Gomes; Simone Vasilij Benatti; Noel Naidoo; Francesco Salvetti; Stefano Maccatrozzo; Vanni Agnoletti; Emiliano Gamberini; Leonardo Solaini; Antonio Costanzo; Andrea Celotti; Matteo Tomasoni; Vladimir Khokha; Catherine Arvieux; Lena Napolitano; Lauri Handolin; Michele Pisano; Stefano Magnone; David A Spain; Marc de Moya; Kimberly A Davis; Nicola De Angelis; Ari Leppaniemi; Paula Ferrada; Rifat Latifi; David Costa Navarro; Yashuiro Otomo; Raul Coimbra; Ronald V Maier; Frederick Moore; Sandro Rizoli; Boris Sakakushev; Joseph M Galante; Osvaldo Chiara; Stefania Cimbanassi; Alain Chichom Mefire; Dieter Weber; Marco Ceresoli; Andrew B Peitzman; Liban Wehlie; Massimo Sartelli; Salomone Di Saverio; Luca Ansaloni Journal: World J Emerg Surg Date: 2017-08-18 Impact factor: 5.469