The significance of pseudoaneurysms in the nonoperative management of pediatric blunt splenic trauma

Kathryn Martin, Lisa Vanhouwelingen, Andreana Bütter

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Purpose: Nonoperative management is the standard of care for hemodynamically stable pediatric and adult blunt splenic injuries. In adults, most centers follow a well-defined protocol involving repeated imaging at 24 to 48 hours, with embolization of splenic pseudoaneurysms (SAPs). In children, the significance of radiologically detected SAP has yet to be clarified. Methods: A systematic review of the medical literature was conducted to analyze the outcomes of documented posttraumatic SAP in the pediatric population. Results: Sixteen articles, including 1 prospective study, 4 retrospective reviews, and 11 case reports were reviewed. Forty-five SAPs were reported. Ninety-six percent of children were reported as stable. Yet, 82% underwent splenectomy, splenorrhaphy, or embolization. The fear of delayed complications owing to SAP was often cited as the reason for intervention in otherwise stable children. Only one child with a documented pseudoaneurysm experienced a delayed splenic rupture while under observation. No deaths were reported. Conclusions: There is no evidence to support or dispute the routine use of follow-up imaging and embolization of posttraumatic SAP in the pediatric population. At present, the decision to treat SAP in stable children is at the discretion of the treating physician. A prospective study is needed to clarify this issue.

Original languageEnglish (US)
Pages (from-to)933-937
Number of pages5
JournalJournal of pediatric surgery
Volume46
Issue number5
DOIs
StatePublished - May 1 2011

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False Aneurysm
Pediatrics
Wounds and Injuries
Prospective Studies
Splenic Rupture
Nonpenetrating Wounds
Dissent and Disputes
Splenectomy
Standard of Care
Population
Fear
Observation
Physicians

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

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abstract = "Purpose: Nonoperative management is the standard of care for hemodynamically stable pediatric and adult blunt splenic injuries. In adults, most centers follow a well-defined protocol involving repeated imaging at 24 to 48 hours, with embolization of splenic pseudoaneurysms (SAPs). In children, the significance of radiologically detected SAP has yet to be clarified. Methods: A systematic review of the medical literature was conducted to analyze the outcomes of documented posttraumatic SAP in the pediatric population. Results: Sixteen articles, including 1 prospective study, 4 retrospective reviews, and 11 case reports were reviewed. Forty-five SAPs were reported. Ninety-six percent of children were reported as stable. Yet, 82{\%} underwent splenectomy, splenorrhaphy, or embolization. The fear of delayed complications owing to SAP was often cited as the reason for intervention in otherwise stable children. Only one child with a documented pseudoaneurysm experienced a delayed splenic rupture while under observation. No deaths were reported. Conclusions: There is no evidence to support or dispute the routine use of follow-up imaging and embolization of posttraumatic SAP in the pediatric population. At present, the decision to treat SAP in stable children is at the discretion of the treating physician. A prospective study is needed to clarify this issue.",
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The significance of pseudoaneurysms in the nonoperative management of pediatric blunt splenic trauma. / Martin, Kathryn; Vanhouwelingen, Lisa; Bütter, Andreana.

In: Journal of pediatric surgery, Vol. 46, No. 5, 01.05.2011, p. 933-937.

Research output: Contribution to journalArticle

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