Pediatric splenic injuries with a contrast blush: successful nonoperative management without angiography and embolization.
BACKGROUND
The presence of a contrast blush on computed tomography (CT) in adult splenic trauma is a risk factor for failure of nonoperative management. Arterial embolization is believed to reduce this failure rate. The significance of a blush in pediatric trauma is unknown. The authors evaluated the outcome of children with blunt splenic trauma and contrast extravasation.


METHODS
The trauma registry was queried for all pediatric patients with blunt splenic injuries. Admission CT was reviewed for injury grade and presence of an arterial blush by a radiologist blinded to patient outcome. Hospital and office charts were reviewed for success of nonoperative management, late splenic rupture, and other complications.


RESULTS
One hundred seven children with blunt splenic trauma were identified over a 6-year period. Mean injury grade was 2.9. Six patients required emergency splenectomy. An additional 7 patients met hemodynamic criteria for surgical intervention (3 splenectomies, 4 splenorrhaphies). Admission CT was available in 63 patients. An arterial blush was identified in 5 (9.7%). Four remained stable and were treated conservatively. One underwent splenectomy for hemodynamic instability. There were no cases of delayed splenic rupture, failed nonoperative treatment, or long-term complications.


CONCLUSIONS
Contrast blush in children with blunt splenic trauma is rare, and its presence alone does not appear to predict delayed rupture or failure of nonoperative treatment. Based on this limited series, splenic artery embolization does not have a place in the management of splenic injuries in children.
Cloutier
David R
DR
Division of Pediatric Surgery, Brown Medical School, Providence, RI, USA.
Baird
Todd B
TB
Gormley
Paula
P
McCarten
Kathleen M
KM
Bussey
J Gibson
JG
Luks
Francois I
FI
D000293:Adolescent; D000792:Angiography; D001158:Arteries / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000493:pharmacokinetics*; D004621:Embolization, Therapeutic; D004630:Emergencies; D005119:Extravasation of Diagnostic and Therapeutic Materials; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D015641:Radiography, Interventional; D012307:Risk Factors; D016037:Single-Blind Method; D013154:Spleen / Q000098:blood supply / Q000000981:diagnostic imaging / Q000293:injuries*; D013156:Splenectomy; D013161:Splenic Rupture / Q000453:epidemiology / Q000517:prevention & control; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D019564:Unnecessary Procedures; D014947:Wounds and Injuries / Q000000981:diagnostic imaging
D003287:Contrast Media