Runyan Bratcher L, Smith R Stephen, Osland Jacqueline S
Department of Surgery, The University of Kansas School of Medicine-Wichita, Wichita, Kansas 67214, USA.
Am Surg. 2008 May;74(5):437-9.
Nonoperative management of splenic injury is standard in hemodynamically stable patients. Splenic artery embolization is a useful adjunct to nonoperative management for patients with ongoing hemorrhage. However, the complications of embolization are not well defined. We report a case of progressive splenomegaly requiring delayed splenectomy after embolization. A 57-year-old hemodynamically stable, blunt trauma patient had a Grade III splenic injury with associated subcapsular hematoma. Nonoperative management was initiated, but his hemoglobin levels progressively declined prompting proximal splenic artery embolization. His hemoglobin levels remained stable postembolization and he was discharged on postinjury day 5. The patient was readmitted 10 days later with increasing abdominal pain and shortness of breath. Repeat CT revealed an enlarged subcapsular fluid collection, but his hemoglobin level remained stable and he was discharged 5 days later. He returned again 2 days later with similar complaints, and CT demonstrated that his subcapsular fluid collection was further enlarged. Repeat hemoglobin level was again stable. The patient requested operative intervention due to intractable pain, and splenectomy was performed without complications. Operative findings included a sterile, contained subcapsular hematoma. Splenic embolization has emerged as an adjunct to nonoperative management of splenic injury; however, the indications for splenic embolization are yet to be defined, and the spectrum and frequency of potential complications are poorly documented. This case report highlights a potentially serious complication that can occur after splenic embolization.
对于血流动力学稳定的患者，脾损伤的非手术治疗是标准方法。脾动脉栓塞术是对持续出血患者进行非手术治疗的一种有用辅助手段。然而，栓塞的并发症尚未明确界定。我们报告一例栓塞后出现进行性脾肿大并需要延迟行脾切除术的病例。一名57岁血流动力学稳定的钝性创伤患者有Ⅲ级脾损伤并伴有包膜下血肿。开始进行非手术治疗，但他的血红蛋白水平逐渐下降，促使进行脾动脉近端栓塞。栓塞后他的血红蛋白水平保持稳定，于受伤后第5天出院。10天后患者因腹痛加重和呼吸急促再次入院。复查CT显示包膜下积液增多，但他的血红蛋白水平仍稳定，5天后出院。2天后他再次因类似症状前来就诊，CT显示其包膜下积液进一步增多。复查血红蛋白水平再次稳定。由于疼痛难以忍受，患者要求手术干预，遂行脾切除术，无并发症发生。手术所见包括一个无菌的、局限的包膜下血肿。脾栓塞术已成为脾损伤非手术治疗的一种辅助手段；然而，脾栓塞的适应证尚未明确界定，潜在并发症的范围和发生率也缺乏充分记录。本病例报告强调了脾栓塞术后可能发生的一种严重并发症。
