Betancourth Alvarenga J E, Santiago Martínez S, Jiménez Gómez S J, San Vicente Vela M B, Gaspar Pérez M, Álvarez García N, Güizzo J R, Jiménez Arribas P, Esteva Miró C, Núñez García B
Pediatric Surgery Department. Parc Taulí Healthcare Corporation Consortium. Sabadell, Barcelona (Spain).
Cir Pediatr. 2022 Apr 1;35(2):80-84. doi: 10.54847/cp.2022.02.16.
Splenic and hepatic pseudoaneurysm (PA) is a rare arteriovenous injury that may occur following abdominal trauma. The most frequent complication of PA is late rupture, which can lead to hemodynamic instability. The objective of this study was to describe our experience in the management of visceral PA.
A retrospective study of patients under 15 years of age with blunt abdominal trauma associated with splenic and/or hepatic injury treated from 2012 to 2020 was carried out. PA formation and management were analyzed. All patients underwent CT-scan, which allowed trauma grade to be established, and also control contrast-enhanced ultrasonography (CEUS) in the first week following trauma. If PA was confirmed, angiography ± percutaneous embolization were performed.
A total of 32 patients with blunt trauma were included. Mean age was 8.7 ± 3.2 years (2-15 years). 68.7% (n = 22) of patients were male. Median trauma grade was grade III (grades II-IV). 33.3% (n = 5/15) of patients developed splenic PA, and 5.8% (n = 1/17) of patients developed hepatic PA, with mean diagnostic time being 3.7 ± 3 (3-8) days. PA formation was associated with higher severity scores, with a mean difference of 15.6 ± 5.3 (95% CI: 4.37:26.14 p < 0.008). All PA cases - except for one, which required urgent splenectomy - were treated with embolization (85.7%) (n = 5/6).
Visceral PA is underdiagnosed, with an incidence higher than reported. Imaging studies (CEUS) are required prior to discharge in the presence of severe trauma. Treatment remains controversial, but we recommend percutaneous embolization, with splenectomy being reserved for unstable patients.
脾和肝假性动脉瘤（PA）是一种罕见的动静脉损伤，可能发生在腹部创伤后。PA最常见的并发症是延迟破裂，可导致血流动力学不稳定。本研究的目的是描述我们在内脏PA治疗方面的经验。
对2012年至2020年期间治疗的15岁以下钝性腹部创伤合并脾和/或肝损伤的患者进行回顾性研究。分析PA的形成和治疗情况。所有患者均接受了CT扫描，以确定创伤等级，并在创伤后的第一周进行了对照增强超声检查（CEUS）。如果PA得到确诊，则进行血管造影±经皮栓塞。
共纳入32例钝性创伤患者。平均年龄为8.7±3.2岁（2至15岁）。68.7%（n = 22）的患者为男性。创伤等级中位数为III级（II至IV级）。33.3%（n = 5/15）的患者发生脾PA，5.8%（n = 1/17）的患者发生肝PA，平均诊断时间为3.7±3（3至8）天。PA的形成与更高的严重程度评分相关，平均差异为15.6±5.3（95%CI：4.37：26.14，p < 0.008）。除1例需要紧急脾切除的病例外，所有PA病例均接受了栓塞治疗（85.7%）（n = 5/6）。
内脏PA诊断不足，发病率高于报道。在存在严重创伤的情况下，出院前需要进行影像学检查（CEUS）。治疗仍存在争议，但我们建议进行经皮栓塞，脾切除术仅适用于不稳定患者。
