Blunt splenic injury. Procedure of appropriate assessment of degree of injury and technique of embolotherapy

The purpose of this study was to assess the role of contrast-enhanced CT in patients with blunt splenic injury and to evaluate technique of transcatheter arterial embolization. Twenty-six patients with blunt splenic injury were retrospectively reviewed; degree of injury, therapy applied and patient outcome. Regarding patients who received angiography, findings on CE-CT and angiograms were compared. Technique of embolotherapy used was recorded. Initial treatment was conservative in 11, embolotherapy in 11, and surgery in 4. Most patients with capsular and subcapsular injury were treated conservatively, while patients with deep parenchymal injury, particularly with a large amount of abdominal bleeding, often required embolotherapy or surgery. Compared to angiography, CT was more sensitive in demonstrating parenchymal injury. In most cases, embolotherapy was performed super selectively for all injured arterial branches with metallic coils. Embolization was usually performed for all branches supplying injured segments on CT, in addition to actively bleeding arteries on angiogram. Treatment was successful in all but 3 cases. In one case who received embolotherapy and re-bleed, embolization was performed only for arteries with active bleeding on angiogram. CE-CT is helpful in making the appropriate choice of treatment. Super selective embolotherapy seemed to be successful when the injured arterial branches are precisely assessed with angiography and CE-CT. (author)