title: The significance of pseudoaneurysms in the nonoperative management of pediatric blunt splenic trauma.
abstract: OBJECTIVE
  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.
authors: Division of Pediatric Surgery, Children's Hospital, London Health Sciences Center, London, Ontario, Canada.
authors: Kathryn
authors: K
authors: Martin
authors: Lisa
authors: L
authors: Vanhouwelingen
authors: Andreana
authors: A
authors: Bütter