The importance of post-traumatic splenic pseudoaneurysm treatment in a child

Abstract

AIM OF THE STUDY: Although splenic traumas are the most frequent solid organ injuries in the pediatric population, post-traumatic splenic pseudoaneurysm (SPA) is a rare condition seen in up to 9% of cases. Regrettably, there are no guidelines addressing the optimal timing for SPA angioembolization in children. This case report aims to consider the importance of angioembolization, which could reduce the risk of fatal complications. CASE DESCRIPTION: A 5-year-old boy was presented to the Emergency Department due to blunt abdominal trauma. Initial observation revealed a distended abdomen with tenderness on the left side. Ultrasound showed a spleen injury and a small amount of intraabdominal fluid, although there were no signs of anemia. Abdominal CT confirmed a III° laceration of the spleen (Image 1). Nonoperative management was chosen and the patient‘s general condition improved. On 6th day, the patient was symptom-free and ready for discharge; however, the ultrasound revealed a pseudoaneurysm in an inferior pole of the spleen. Later that day, the boy suddenly experienced severe abdominal pain, hypotension, and collapse, prompting a bedside ultrasound that identified an increased volume of intraabdominal fluid, along with a decreased hemoglobin level in a blood test. The patient underwent urgent laparotomy and splenectomy due to a rupture of splenic pseudoaneurysm. The post-operative period was uneventful, and the patient was discharged on the 9th day. CONCLUSION: While this case resulted in a successful outcome it emphasizes the current lack of clear guidelines for the timely consideration of angioembolization of SPA - potentially a lifesaving decision.