Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2024; 16(10): 3163-3170
Published online Oct 27, 2024. doi: 10.4240/wjgs.v16.i10.3163
Follow-up strategy for early detection of delayed pseudoaneurysms in patients with blunt traumatic spleen injury: A single-center retrospective study
Sung Hoon Cho, Gun Woo Kim, Suyeong Hwang, Kyoung Hoon Lim
Sung Hoon Cho, Gun Woo Kim, Suyeong Hwang, Kyoung Hoon Lim, Department of Surgery, Trauma Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
Author contributions: Kim GW and Hwang S did the acquisition and analysis of the data; Cho SH performed data collection and statistical analysis and was a major contributor to writing the manuscript; Lim KH contributed to the conception and design of the work and revised manuscript. All authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of the Kyungpook National University Hospital (Approval No. 2023-12-016).
Informed consent statement: This study is a retrospective study analyzing electronic medical records and is subject to exemption from consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data are included in the main manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kyoung Hoon Lim, MD, PhD, Doctor, Professor, Surgeon, Department of Surgery, Trauma Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, 130, Dongduk-ro, Jung-gu, Daegu 41944, South Korea. drlimkh@knu.ac.kr
Received: May 9, 2024
Revised: August 22, 2024
Accepted: August 30, 2024
Published online: October 27, 2024
Processing time: 141 Days and 23.8 Hours
Abstract
BACKGROUND

The spleen is the most commonly injured solid organ in blunt abdominal trauma, and splenic pseudoaneurysm rupture is associated with a high risk of mortality. Nonoperative management has become the standard treatment for hemodynamically stable patients with splenic injuries. On the other hand, delayed splenic pseudoaneurysms can develop in any patient, and at present, there are no known risk factors that may reliably predict their occurrence. Furthermore, there is a lack of consensus regarding the most appropriate strategies for monitoring and managing splenic injuries, especially lower-grade (I-III).

AIM

To determine the predictors of pseudo-aneurysm formation following splenic injury and develop follow-up strategies for early detection of pseudoaneurysms.

METHODS

We retrospectively analyzed patients who visited the Level I Trauma Center between January 2013 and December 2022 and were diagnosed with spleen injuries after blunt abdominal trauma.

RESULTS

Using the American Association for the Surgery of Trauma spleen injury scale, the splenic injuries were categorized into the following order based on severity: Grade I (n = 57, 17.6%), grade II (n = 114, 35.3%), grade III (n = 89, 27.6%), grade IV (n = 50, 15.5%), and grade V (n = 13, 4.0%). Of a total of 323 patients, 35 underwent splenectomy and 126 underwent angioembolization. 19 underwent delayed angioembolization, and 5 under-went both initial and delayed angioembolization. In 14 patients who had undergone delayed angioembolization, no extravasation or pseudoaneurysm was observed on the initial computed tomography scan. There are no particular patient-related risk factors for the formation of a delayed splenic pseudoaneurysm, which can occur even in a grade I spleen injury or even 21 days after the injury. The mean detection time for a delayed pseudoaneurysm was 6.26 ± 5.4 (1-21, median: 6, interquartile range: 2-9) days.

CONCLUSION

We recommend regular follow-up computed tomography scans, including an arterial and portal venous phase, at least 1 week and 1 month after injury in any grade of blunt traumatic spleen injury for the timely detection of delayed pseudoaneurysms.

Keywords: Blunt trauma; Spleen injury; Delayed pseudoaneurysm; Angioembolization; Nonoperative management

Core Tip: Nonoperative management has become the standard treatment for hemodynamically stable patients with splenic injuries. On the other hand, delayed splenic pseudoaneurysms can develop in any patient, and at present, there are no known risk factors that may reliably predict their occurrence. There were also no statistically significant risk factors for delayed pseudoaneurysm formation in our study. We recommend regular follow-up computed tomography scans at least 1 week and 1 month after injury in any grade of blunt traumatic spleen injury.