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Abstrakt

Analysis of Pseudoaneurysms in Solid Organs after Blunt Abdominal Injury in Pediatric age group Treated at an Emergency Center

Tadashi Ishihara, Inoue Y, Nishiyama K, Sueyoshi K, Sumi Y, Matsuda S, Okamoto K and Tanaka H

Background: Pediatric trauma patients present unique clinical challenges such as different mechanisms of injury, physiological responses, and indications for operative versus nonoperative management compared to adults. Nonoperative management for blunt abdominal trauma is generally preferred in hemodynamically stable children and its outcomes are generally excellent. However, therapeutic strategy for pseudoaneurysms (PA) after solid organ injury (SOI) is controversial.
Methods: Patients aged ≤ 15 years admitted to our hospital from April 2008 to March 2014 because of blunt abdominal trauma were enrolled in this study. The patients were divided into two groups: those complicated with PA (PA group) or without PA (non-PA group). Result: Among the 294 patients admitted with abdominal injury, 17 were enrolled in this study. No significant differences in patient characteristics, treatment course, or outcomes between the PA (n=4) and non-PA (n=13) groups were detected. All PA cases resolved spontaneously with close observation.
Discussion: All PA cases were treated conservatively without the need for surgical procedures, including transarterial embolization, which is frequently required for adult PA cases after SOI; however, no consensus on transarterial embolization for pediatric cases has been reached, owing to its technical difficulty and potential complications. Our analysis suggested that PA after abdominal SOI can be successfully managed conservatively.
Conclusion: Although the length of hospital stay and the period of restriction from full activity tended to be long, all our pediatric PA cases achieved spontaneous occlusion without any complications. Life-threatening complications such as delayed rupture of PA are rare and thus close observation is one of the best methods for treating hemodynamically stable children with PA caused by blunt abdominal trauma.