Nonsurgical management of patients with blunt splenic injury: efficacy of transcatheter arterial embolization.

OBJECTIVE: We evaluated the efficacy of nonsurgical management of patients with blunt splenic injury using detailed angiographic examinations and transcatheter arterial embolization.

SUBJECTS AND METHODS: We prospectively studied 228 patients who had blunt abdominal injury and for whom CT was performed. When splenic injury was revealed by CT, angiography was performed in all patients except those requiring emergency surgery. Transcatheter arterial embolization was performed when patients had the following angiographic criteria: (1) extravasation of contrast material extending beyond or within the splenic parenchyma, (2) arterial disruption or major arteriovenous fistula, or (3) both. Splenic function was subsequently estimated by 99mTc-sulfur colloid scintigraphy and repeat angiography.

RESULTS: Of 228 patients with blunt trauma, 31 patients had CT evidence of splenic injury. In three of these 31 patients, emergency laparotomy was performed before angiography because of an associated injury or unstable circulatory status. In 13 of the 28 remaining patients, transcatheter arterial embolization was not required as these patients did not meet the necessary criteria. They were treated with bed rest. Transcatheter arterial embolization was performed in the remaining 15 patients and was completely successful in 13. Because one of these 13 patients died of a brain contusion, follow-up angiography and scintigraphy were performed in the remaining 12 patients and showed preservation of splenic function. Nonsurgical treatment of splenic injury with angiography was successful in 93% of patients.

CONCLUSION: Our success rate for nonsurgical management of patients with blunt splenic injury should encourage more extensive evaluation and use of angiography for splenic injury and the subsequent management of splenic injury without surgery.