Failed splenic salvage strategy after trauma: A septic infarction after arterial percutaneous selective embolization

Abstract text (incl. references and figure legends)

Case History:

61 y/o male, with medical history of DM type II, victim of a motorcycle front collision accident and ejection from vehicle. In a urgent CT Splenic IV grade injury was documented without active bleeding. In a control abdomen CT, multiple postraumatic splenic pseudoaneurisym were reported and a percutaneos selective arterial embolization was made without incidences. Two weeks later after discharge, the patient returned to the ED for abdominal pain and fever.

Clinical Findings:

The patient arrives to the ED hemodynamically stable, tachycardic and febrile. Abdominal tenderness in left upper quadrant and peritoneal irritation was documented.

Investigation

Increased acute phase reactant in the blood test and a splenic infected infarction was seen in the CT were found.

Diagnosis

Septic splenic infraction post arterial embolization

Therapy

Antibiotics and symptomatic treatment was initially established, but, given persistent fever and clinical and laboratory worsening, urgent splenectomy was performed

Comments

Endovascular treatment for postraumatic solid organs injuries had change the algorithm in the politraumatized patient. In the last decades, the increasing demand of embolization had highlighted its complications. Our case is one of the most frequent complication after arterial embolization but, usually, the splenic salvage strategy is effective. It is important to recognize when the non operative treatment is failing for prompt splenectomy.

References:

1. SPLEnic salvage and complications aftervsplenic artery EmbolizatioN for blunt abdomINal trauma: the SPLEEN-IN study, Warren Clements, 2020

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