Proximal splenic artery embolization in the management of splenic rupture

Geoff A Bellingham, Stewart Kribs, Anat Kornecki, Leslie Scott, Michael Leaker, Douglas D Fraser
Pediatric Critical Care Medicine 2009, 10 (1): e1-4

OBJECTIVE: To report the use of proximal splenic artery embolization for management of spontaneous splenic rupture.

DESIGN: Case report and literature review.

SETTING: A tertiary pediatric critical care unit in a university teaching hospital.

INTERVENTIONS: Proximal splenic artery embolization.

MEASUREMENTS AND MAIN RESULTS: An 8-yr-old boy presented with abdominal pain radiating to the left shoulder 9 days after completing induction chemotherapy for acute lymphoblastic leukemia. Imaging revealed a splenic rupture with parenchymal and subcapsular hematomas, with no evidence of active extravasations. The patient was admitted to the pediatric critical care unit for close hemodynamic monitoring and frequent measurements of hemoglobin. His lowest recorded hemoglobin and hematocrit were 63 g/L and 0.19 L/L, respectively. Posttransfusion of packed red blood cells, he was taken to interventional radiology for proximal splenic artery embolization under moderate sedation. Several coils were successfully placed in the proximal splenic arterial system resulting in a marked reduction of splenic blood flow without disruption of collaterals. The patient recovered well from proximal splenic artery embolization in the pediatric critical care unit and experienced short lasting abdominal pain and fever for 1 day. He was discharged home 4 days after the procedure and follow-up imaging showed resolving hematomas with preserved splenic blood flow.

CONCLUSION: Proximal splenic artery embolization in children may be a safe therapeutic alternative to either conservative or surgical management in spontaneous splenic rupture. Preservation of splenic tissue with a reduced risk of repeated hemorrhage can be obtained with proximal splenic artery embolization.

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