Splenic laceration with embolization

Case contributed by RMH Core Conditions

Presentation

Motorbike collision.

Patient Data

Age: 35
Gender: Male

Large amount of high density intraperitoneal free fluid is consistent with hemoperitoneum, significantly increased in size since previous study.

Multiple hypodensities within the spleen consistent with lacerations have increased in size. There is a large 3 cm hypodense mass within the anterior part of the spleen producing local mass effect with bulging of the anteromedial capsule. This may represent a false aneurysm. Multifocal curvilinear enhancing foci within the spleen may represent contrast extravasation (most likely venous), as well as possible AV fistulae.

The inferior vena cava is partially collapsed and the portal vein is reduced in diameter since previous study, suggesting hypovolemia.

Conclusion:

Large amount of hemoperitoneum has accumulated since previous study.

The most likely origin is from the extensive splenic lacerations, with a possible newly formed splenic false aneurysm and AV fistula.

DSA (angiography)

Preliminary selective splenic angiography, confirming splenic upper pole laceration with active bleeding/pseudoaneurysm formation.

The main splenic artery upper pole branch was then superselected, followed by transcatheter embolization with a total of 6 x fibered platinum coils (VortX, Boston Scientific) ranging from 2-6 mm diameter to acceptable stasis.

Case Discussion

The advantage of splenic embolization over splenectomy is that some splenic function is maintained. 

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Case information

rID: 34214
Published: 10th Feb 2015
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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