Yechiel Sweed1,2, Jonathan Singer-Jordan3,4, Sorin Papura3,4, Norman Loberant5,6, Alon Yulevich1,2. 1. Departments of Pediatric Surgery. 2. Interventional Radiology, Galilee Medical Center, Nahariya, Israel. 3. Departments of Interventional Radiology. 4. Radiology, Galilee Medical Center, Nahariya, Israel. 5. Department of Interventional Radiology. 6. Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.
Abstract
BACKGROUND: Trauma is the leading cause of childhood morbidity and mortality. Abdominal bleeding is one of the common causes of mortality due to trauma. Angiography and embolization are well recognized as the primary treatments in certain cases of acute traumatic hemorrhage in adults; however, evidence is lacking in the pediatric population. OBJECTIVES: To assess the safety and efficacy of transcatheter arterial embolization (TAE) for blunt and penetrating abdominal and pelvic trauma in the pediatric age group. METHODS: Three children with blunt abdominal trauma and one child with iatrogenic renal injury (age 4-13 years) were managed with TAE for lacerated liver (one patient), pelvic fractures (one patient) and renal injuries (two patients). The first two patients, victims of road accidents, had multisystem injuries and were treated by emergency embolization after fluid resuscitation in the Emergency Department (ED). The other two patients had renal injuries: a 4 year old boy with blunt abdominal trauma was diagnosed on initial computed tomography with an unexpected Wilms tumor and was treated with embolization 1 day after admission due to hemodynamic deterioration caused by active arterial tumor bleeding. The following day he underwent successful nephrectomy. The other patient was 13 year old boy with nephrotic syndrome who underwent renal biopsy and developed hemodynamic instability. After fluid resuscitation, he underwent an initial negative angiography, but second-look angiography the following day revealed active bleeding from an aberrant renal artery, which was then successfully embolized. RESULTS: In all four patients, TAE was diagnostic as well as therapeutic, and no child required surgical intervention for control of bleeding. CONCLUSIONS: We propose that emergency transcatheter angiography and arterial embolization be considered following resuscitation in the ED as initial treatment in children with ongoing bleeding after blunt abdominal trauma or iatrogenic renal injury. Implementation of this policy demands availability and cooperation of the interventional radiology services.
BACKGROUND:Trauma is the leading cause of childhood morbidity and mortality. Abdominal bleeding is one of the common causes of mortality due to trauma. Angiography and embolization are well recognized as the primary treatments in certain cases of acute traumatic hemorrhage in adults; however, evidence is lacking in the pediatric population. OBJECTIVES: To assess the safety and efficacy of transcatheter arterial embolization (TAE) for blunt and penetrating abdominal and pelvic trauma in the pediatric age group. METHODS: Three children with blunt abdominal trauma and one child with iatrogenic renal injury (age 4-13 years) were managed with TAE for lacerated liver (one patient), pelvic fractures (one patient) and renal injuries (two patients). The first two patients, victims of road accidents, had multisystem injuries and were treated by emergency embolization after fluid resuscitation in the Emergency Department (ED). The other two patients had renal injuries: a 4 year old boy with blunt abdominal trauma was diagnosed on initial computed tomography with an unexpected Wilms tumor and was treated with embolization 1 day after admission due to hemodynamic deterioration caused by active arterial tumor bleeding. The following day he underwent successful nephrectomy. The other patient was 13 year old boy with nephrotic syndrome who underwent renal biopsy and developed hemodynamic instability. After fluid resuscitation, he underwent an initial negative angiography, but second-look angiography the following day revealed active bleeding from an aberrant renal artery, which was then successfully embolized. RESULTS: In all four patients, TAE was diagnostic as well as therapeutic, and no child required surgical intervention for control of bleeding. CONCLUSIONS: We propose that emergency transcatheter angiography and arterial embolization be considered following resuscitation in the ED as initial treatment in children with ongoing bleeding after blunt abdominal trauma or iatrogenic renal injury. Implementation of this policy demands availability and cooperation of the interventional radiology services.
Authors: Roy Spijkerman; Lauren C M Bulthuis; Lillian Hesselink; Thomas M P Nijdam; Luke P H Leenen; Ivar G J M de Bruin Journal: Eur J Trauma Emerg Surg Date: 2020-02-11 Impact factor: 3.693