Angiographic embolization is safe and effective therapy for blunt abdominal solid organ injury in children

J Trauma. 2010 Mar;68(3):526-31. doi: 10.1097/TA.0b013e3181d3e5b7.

Abstract

Background: : Angiographic embolization (AE) is used to control hemorrhage in adult blunt liver, spleen, and kidney (ASO) injuries. Pediatric experience with AE for blunt ASO injuries is limited. We reviewed our use of AE to control bleeding pediatric blunt ASO injuries for efficacy and safety.

Methods: : A 5-year review (trauma registry and charts) of children (age < or = 16 years) who had AE for hemorrhage from blunt ASO injuries. Nonoperative management was attempted in all stable children with blunt ASO injuries. Children with ongoing hemorrhage underwent AE. The success of AE and complications were evaluated. Data were reviewed on injury type and grade, injury severity score, length of intensive care unit stay (LOS-ICU) and length of hospital stay (LOS), and complications.

Results: : One hundred twenty-seven patients with 149 blunt ASO injuries were identified (72 spleen, 51 liver, and 26 renal). Two children had immediate splenectomies. Seven children underwent AE: two spleen (grades IV and V), two liver (grades III and IV), and three grade IV renal injuries. Three children received blood before embolization. Mean age and injury severity score were 12.3 years +/- 3.7 years and 22.4 +/- 10.0,respecyively. Mean intensive care unit stay was 4.8 days +/- 5.5 days with a mean length of hospital stay of 12.8 days +/- 5.5 days. Embolization was successful in all children; there were no procedure-related complications. Four minor complications occurred; two pleural effusions and two patients with transient hypertension. A nephroblastoma was later found in one renal injury requiring nephrectomy.

Conclusions: : AE is a safe and an effective technique for controlling hemorrhage from blunt ASO injuries in select pediatric patients.

MeSH terms

  • Abdominal Injuries / diagnostic imaging
  • Abdominal Injuries / therapy*
  • Adolescent
  • Angiography
  • Child
  • Cohort Studies
  • Embolization, Therapeutic*
  • Female
  • Humans
  • Kidney / injuries*
  • Liver / injuries*
  • Male
  • Retrospective Studies
  • Spleen / injuries*
  • Treatment Outcome
  • Wounds, Nonpenetrating / diagnostic imaging
  • Wounds, Nonpenetrating / therapy*