Детская хирургия. Журнал им. Ю.Ф. Исакова. 2021; 25: 405-410
Множественные посттравматические псевдоаневризмы селезёнки у ребёнка 13 лет
https://doi.org/10.55308/1560-9510-2021-25-6-405-410Аннотация
Введение. До настоящего времени продолжаются споры относительно стратегии лечения псевдоаневризм селезёнки, которые выявляются при КТ-визуализации.
Цель – представить лечебно-диагностический алгоритм при травме селезёнки, осложнившейся формированием множественных псевдоаневризм, у ребёнка 13 лет.
Описание клинического наблюдения. Мальчик 13 лет, получил травму в результате ДТП (велосипедист, сбит легковым автомобилем) и был госпитализирован в экстренном порядке с диагнозом: сотрясение головного мозга. Ссадины и ушибы мягких тканей. На 2-е сутки после травмы ребёнок отметил появление болевого синдрома в левой поясничной области. При мультифазной спиральной компьютерной томографии (СКТ) была диагностирована травма нижнего полюса селезёнки с формированием в артериальную фазу множественных округлых гиперденсных образований, исчезающих в портальную фазу. По данным УЗИ, в нижнем полюсе селезёнки выявлены множественные гипоэхогенные зоны до 8 мм в диаметре, в которых в режиме цветного доплеровского картирования (ЦДК) регистрировался кровоток. Установлен диагноз: закрытая травма селезёнки IV степени (AAST). Множественные псевдоаневризмы нижнего полюса селезёнки. При повторной СКТ на 6-е сутки после травмы, как и при УЗИ, отмечено исчезновение псевдоаневризм. В катамнезе через 6 мес после травмы жалоб нет, структура селезёнки при УЗИ соответствует возрастной норме.
Заключение. Представленное клиническое наблюдение демонстрирует успешность консервативного лечения травмы селезёнки, осложнившейся формированием множественных псевдоаневризм.
Список литературы
1. Подкаменев В.В., Подкаменев А.В. Неоперативное лечение повреждений селезенки у детей: риск отсроченных осложнений. Детская хирургия. 2014; 4(18): 38-42.
2. Lynn K.N., Werder G.M., Callaghan R.M. Pediatric blunt splenic trauma: a comprehensive review. Pediatr. Radiol. 2009; 39: 904-16.
3. Upadhyaya P. Conservative management of splenic trauma: history and current trends. Pediatr Surg Int. 2003; 19: 617-27.
4. Sharma O.P., Oswanski M.F., Singer D., Raj S.S., Daoud Y.A.H. Assessment of non operative management of blunt spleen and liver trauma. Am Surg. 2005; 71: 379–86.
5. Schurr M.J., Fabian T.C., Gavant M., et al. Management of blunt splenic trauma: computed homographic contrast blush predicts failure of non operative management. J Trauma, 1995; 39: 507-13.
6. Davis K.A., Fabian T.C., Croce M.A., et al. Improved success in no operative management of blunt splenic injuries: embolization of splenic artery pseudoaneurysms J Trauma. 1998; 44: 1008-13.
7. Raikhlin A., Otto Baerlocher M., Asch M.R., et al. Imaging and transcatheter arterial embolization for traumatic splenic injuries: review of the literature/ Can J Surg. 2008; 52: 464-72.
8. Mayglothling J.A., Haan J.M., Scalea T.M. Blunt splenic injuries in the adolescent trauma population: the role of angiography andembolization. J Emerg Med. 2011; 41(1): 21-8.
9. Gaarder J.B., Dormagen T., Eken, et al. Non operative management of splenic in juries: improved results with angioembolization. J Trauma. 2006; 61: 192-8.
10. Gow K.W., Murphy III J.J., Blair G.K. Splenchnic artery pseudoaneurysmys secondary to blunt abdominal trauma in children. J. Pediatr. Surg. 1996; 31(6): 812–5.
11. Martin K., Van Houwelingen L., Bütter A. The significance of pseudoaneurysms in the non operative management of pediatric blunt splenic trauma. J. Pediatric Surgery. 2011; 46(5): 933–7.
12. Frumiento C., Sartorelli K., Vane D., Complications of splenic injuries: expansion of the nonoperative theorem, J Pediatr Surg. 2000; 35: 788-91.
13. Engelke C., Quarmby J., Ubhayakar G., et al. Autologous thrombin: a new embolization treatment for traumatic intra splenic pseudoaneurysm, J Endovasc Ther. 2002; 9: 29-35.
14. M.K. Maloo, P.E. Burrows, R.C. Shamberger, Traumatic splenic arteriovenous fistula: splenic conservation by embolizatio. J Trauma. 1999; 47: 173-5.
15. Oguz B., Cil B., Ekinci S., Karnak I., Akata D., Haliloglu M. Posttraumatic splenic pseudoaneurysm and arteriovenous fistula: diagnosis by computed tomography angiography and treatment by transcatheter embolization. J Pediatric Surg. 2005; 40 (12): e43–6.
16. Yardeni D., Polley T.Z., Coran A.G., Splenic artery embolization for post-traumatic splenic artery pseudoaneurysm in children. J Trauma. 2004: 57: 404-7.
17. Dobremez E., Lefevre Y., Harper L., et al. Complications occurring during conservative management of splenic trauma in children. Eur J Pediatr Surg. 2006; 16 :166-70.
18. Durkin N., Deganello A., Sellars M.E., Sidhu P.S., Davenport M., Makin E. Post-traumatic liver and splenic pseudoaneurysms in children: diagnosis, management, and follow-up screening using contrast enhanced ultrasound. J. Pediatric Surgery. 2015; 51(2): 289–92.
19. Safavi A., Beaudry P., Jamieson D., Murphy J.J. Traumatic pseudoaneurysms of the liver and spleen in children: is routine screening warranted? J. Pediatr. Surg. 2011; 46(5): 938–41.
20. Muroya T., Ogura H., Shimizu K., et al. Delayed formation of splenic pseudoaneurysm following nonoperative management in blunt splenic injury: multi-institutional study in Osaka, Japan, J. Trauma Acute Care Surg. 2013; 75(3): 417-20.
21. Katsura M., Fukuma S., Kuriyama A., Takada T., Ueda Y., Asano S., Kondo Y., Ie M., and others. Association between contrast extravasation on computed tomography scans and pseudoaneurysm formation in pediatric blunt splenic and hepatic injury: a multi-institutional observational study. J. Pediatric Surgery. 2019; 55 (4): 681–7.
22. Notrica D.M., Eubanks J.W. 3rd, Tuggle D.W., et al. Non operative management of blunt liver and spleen injury in children: evaluation of the ATOMAC guideline using GRADE. J Trauma Acute Care Surg. 2015; 79(4): 683–93.
23. Bansal S., Karrer F.M., Hansen K., et al. Contrast blush in pediatric blunt splenic trauma does not warrant the routine use of angiography and embolization. Am J Surg. 2015; 210: 345-50.
24. Jesinger R.A., Thoreson A.A., Lamba R. Abdominal and pelvic aneurysms and pseudoaneurysms: imaging review with clinical, radiologic, and treatment correlation. Radiographics. 2013; 33: E71-96. https://doi.org/10.18821/1560-9510-2021-25-6 (In Russian)
Russian Journal of Pediatric Surgery. 2021; 25: 405-410
Multiple posttraumatic pseudoaneurisms of the spleen in a 13-year old child
https://doi.org/10.55308/1560-9510-2021-25-6-405-410Abstract
Introduction. Until now, there is an ongoing controversy regarding the curative strategy in spleen pseudoaneurysms which are detected by CT imaging.
Purpose. To present a diagnostic and curative algorithm for treating spleen injury complicated by multiple pseudoaneurysms in a 13-year-old child.
Observation. A 13-year-old boy was injured in a traffic accident (a cyclist hit by a car) and was admitted to the hospital by an ambulance with brain concussion, abrasions and bruises of soft tissues. On the second day after the injury, the child complained of the pain in the left lumbar region. Multiphase spiral computed tomography (MSCT) revealed damage of the lower pole of the spleen with formation of multiple round hyperdense formations in the arterial phase disappearing in the portal phase. Ultrasound examination revealed multiple hypoechoic zones up to 8 mm in diameter in the lower pole of the spleen, in which blood flow was seen at the color Doppler mapping (CDM). Diagnosis: closed trauma of the spleen, Grade 4 (AAST). Multiple pseudoaneurysms of the lower pole of the spleen. Repeated MSCT on the 6th day after the injury registered disappearance of pseudoaneurysms, like it was at the ultrasound examination. In six months after the injury, there were no complaints; spleen structure at ultrasound examination corresponded to age normal parameters.
Conclusion. The presented clinical observation demonstrates the success of conservative treatment of spleen injury complicated by the formation of multiple pseudoaneurysms.
References
1. Podkamenev V.V., Podkamenev A.V. Neoperativnoe lechenie povrezhdenii selezenki u detei: risk otsrochennykh oslozhnenii. Detskaya khirurgiya. 2014; 4(18): 38-42.
2. Lynn K.N., Werder G.M., Callaghan R.M. Pediatric blunt splenic trauma: a comprehensive review. Pediatr. Radiol. 2009; 39: 904-16.
3. Upadhyaya P. Conservative management of splenic trauma: history and current trends. Pediatr Surg Int. 2003; 19: 617-27.
4. Sharma O.P., Oswanski M.F., Singer D., Raj S.S., Daoud Y.A.H. Assessment of non operative management of blunt spleen and liver trauma. Am Surg. 2005; 71: 379–86.
5. Schurr M.J., Fabian T.C., Gavant M., et al. Management of blunt splenic trauma: computed homographic contrast blush predicts failure of non operative management. J Trauma, 1995; 39: 507-13.
6. Davis K.A., Fabian T.C., Croce M.A., et al. Improved success in no operative management of blunt splenic injuries: embolization of splenic artery pseudoaneurysms J Trauma. 1998; 44: 1008-13.
7. Raikhlin A., Otto Baerlocher M., Asch M.R., et al. Imaging and transcatheter arterial embolization for traumatic splenic injuries: review of the literature/ Can J Surg. 2008; 52: 464-72.
8. Mayglothling J.A., Haan J.M., Scalea T.M. Blunt splenic injuries in the adolescent trauma population: the role of angiography andembolization. J Emerg Med. 2011; 41(1): 21-8.
9. Gaarder J.B., Dormagen T., Eken, et al. Non operative management of splenic in juries: improved results with angioembolization. J Trauma. 2006; 61: 192-8.
10. Gow K.W., Murphy III J.J., Blair G.K. Splenchnic artery pseudoaneurysmys secondary to blunt abdominal trauma in children. J. Pediatr. Surg. 1996; 31(6): 812–5.
11. Martin K., Van Houwelingen L., Bütter A. The significance of pseudoaneurysms in the non operative management of pediatric blunt splenic trauma. J. Pediatric Surgery. 2011; 46(5): 933–7.
12. Frumiento C., Sartorelli K., Vane D., Complications of splenic injuries: expansion of the nonoperative theorem, J Pediatr Surg. 2000; 35: 788-91.
13. Engelke C., Quarmby J., Ubhayakar G., et al. Autologous thrombin: a new embolization treatment for traumatic intra splenic pseudoaneurysm, J Endovasc Ther. 2002; 9: 29-35.
14. M.K. Maloo, P.E. Burrows, R.C. Shamberger, Traumatic splenic arteriovenous fistula: splenic conservation by embolizatio. J Trauma. 1999; 47: 173-5.
15. Oguz B., Cil B., Ekinci S., Karnak I., Akata D., Haliloglu M. Posttraumatic splenic pseudoaneurysm and arteriovenous fistula: diagnosis by computed tomography angiography and treatment by transcatheter embolization. J Pediatric Surg. 2005; 40 (12): e43–6.
16. Yardeni D., Polley T.Z., Coran A.G., Splenic artery embolization for post-traumatic splenic artery pseudoaneurysm in children. J Trauma. 2004: 57: 404-7.
17. Dobremez E., Lefevre Y., Harper L., et al. Complications occurring during conservative management of splenic trauma in children. Eur J Pediatr Surg. 2006; 16 :166-70.
18. Durkin N., Deganello A., Sellars M.E., Sidhu P.S., Davenport M., Makin E. Post-traumatic liver and splenic pseudoaneurysms in children: diagnosis, management, and follow-up screening using contrast enhanced ultrasound. J. Pediatric Surgery. 2015; 51(2): 289–92.
19. Safavi A., Beaudry P., Jamieson D., Murphy J.J. Traumatic pseudoaneurysms of the liver and spleen in children: is routine screening warranted? J. Pediatr. Surg. 2011; 46(5): 938–41.
20. Muroya T., Ogura H., Shimizu K., et al. Delayed formation of splenic pseudoaneurysm following nonoperative management in blunt splenic injury: multi-institutional study in Osaka, Japan, J. Trauma Acute Care Surg. 2013; 75(3): 417-20.
21. Katsura M., Fukuma S., Kuriyama A., Takada T., Ueda Y., Asano S., Kondo Y., Ie M., and others. Association between contrast extravasation on computed tomography scans and pseudoaneurysm formation in pediatric blunt splenic and hepatic injury: a multi-institutional observational study. J. Pediatric Surgery. 2019; 55 (4): 681–7.
22. Notrica D.M., Eubanks J.W. 3rd, Tuggle D.W., et al. Non operative management of blunt liver and spleen injury in children: evaluation of the ATOMAC guideline using GRADE. J Trauma Acute Care Surg. 2015; 79(4): 683–93.
23. Bansal S., Karrer F.M., Hansen K., et al. Contrast blush in pediatric blunt splenic trauma does not warrant the routine use of angiography and embolization. Am J Surg. 2015; 210: 345-50.
24. Jesinger R.A., Thoreson A.A., Lamba R. Abdominal and pelvic aneurysms and pseudoaneurysms: imaging review with clinical, radiologic, and treatment correlation. Radiographics. 2013; 33: E71-96. https://doi.org/10.18821/1560-9510-2021-25-6 (In Russian)
