Delayed presentation of splenic artery pseudoaneurysm: A critical outcome of blunt abdominal trauma; A case report.

INTRODUCTION AND IMPORTANCE

Blunt abdominal trauma is one of the most common reasons for emergency department visits, and spleen and splenic vasculature is involved variably in those cases. Splenic artery pseudoaneurysm formation is one complication with potentially devastating consequences. Early detection and management are of paramount importance given its potential fatality. Management includes open repair with or without splenectomy, and endovascular approach. The minimally invasive endovascular treatment offers earlier recovery, preserved splenic function, and positive outcomes. We report a case of delayed presentation of a large splenic artery pseudoaneurysm after blunt abdominal trauma, managed using endovascular intervention.

CASE PRESENTATION

A 45-year-old male presented 10 days after being involved in a pedestrian accident with blunt abdominal trauma resulting in a large splenic artery pseudoaneurysm. After multidisciplinary discussion, the decision was to take him for endovascular treatment. The patient recovered very well and was discharged two days later and followed up in an outpatient setting. Over a year, he became symptom free, and demonstrated radiological finding of shrinking pseudoaneurysm.

CLINICAL DISCUSSION

Pseudoaneurysms of visceral arteries are repaired regardless of their size per society of vascular surgery guidelines. Larger ones are at higher risk of rupture and are associated with high mortality. When discovered, treatment plans should be readily discussed, and undertaken. In our case, the patient had a 6.5 cm splenic artery pseudoaneurysm, and a multidisciplinary meeting was conducted and concluded that endovascular treatment would be the best modality to start with, with surgical option as a backup in a hybrid room setting.

CONCLUSION

Blunt abdominal trauma can present with overt symptoms of internal organ injury; however, some might be missed and need high index of suspicion and therefore further testing and imaging. Splenic artery pseudoaneurysms can expand and rupture in delayed presentation, early detection and management is of paramount importance. Endovascular treatment represents an excellent modality, with minimal invasive nature, faster recovery, and early return to daily activity with preserved splenic function.