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Proximal splenic artery embolization in the management of splenic rupture
Geoff A Bellingham1, Stewart Kribs, Anat Kornecki
1Departments of Anesthesia and Perioperative Medicine, University of Western Ontario, London, ON, Canada.
Insights
Proximal splenic artery embolization is a safe treatment for spontaneous splenic rupture in children. This minimally invasive procedure helps preserve splenic tissue and reduces the risk of bleeding.
Area of Science:
- Interventional Radiology
- Pediatric Critical Care
- Vascular Surgery
Background:
- Spontaneous splenic rupture is a rare but serious condition, particularly in children with hematologic malignancies.
- Traditional management options include conservative observation or surgical splenectomy, each with potential drawbacks.
Observation:
- An 8-year-old boy with acute lymphoblastic leukemia developed spontaneous splenic rupture with significant hematomas.
- The patient presented with abdominal pain and was hemodynamically monitored in a pediatric critical care unit.
Findings:
- Proximal splenic artery embolization was successfully performed using coils to reduce splenic blood flow while preserving collaterals.
- The procedure led to rapid recovery, with resolution of symptoms and resolving hematomas on follow-up imaging.
- No significant complications were noted, and splenic blood flow was preserved.
Implications:
- Proximal splenic artery embolization offers a safe and effective alternative to surgery or conservative management for pediatric spontaneous splenic rupture.
- This technique may allow for spleen preservation, potentially mitigating long-term complications associated with splenectomy.
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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