World Journal of Surgery

, Volume 32, Issue 3, pp 476–482 | Cite as

Complications Associated With Embolization in the Treatment of Blunt Splenic Injury

  • Shih-Chi Wu
  • Ray-Jade Chen
  • Albert D. Yang
  • Cheng-Cheng Tung
  • Kun-Hua Lee



Nonoperative management (NOM) of blunt splenic injuries is widely accepted, and the use of splenic artery embolization (SAE) has become a valuable adjunct to NOM. We retrospectively review and discuss the complications derived from SAE.

Materials and methods

The medical records of 152 consecutive patients with blunt splenic trauma admitted to our trauma center during a 33-month period were retrospectively reviewed. The patients were managed according to an established algorithm. The record review focused on the method of patient management (operative versus nonoperative) and use of SAE. The complications encountered following SAE are discussed in detail.


Altogether, 73 patients underwent emergency surgery (58 splenectomies, 15 splenorrhaphies), and 79 patients had NOM. Of the 79 patients with NOM, 58 were successfully treated; 2 patients required splenectomy after 24 hours. The remaining 21 patients had SAE, including 18 distal and 3 proximal embolizations. Major complications occurred in 28.5% of the SAE-treated patients and included total splenic infarction, splenic atrophy, and postprocedure bleeding. Minor complications occurred in 61.9% of the patients and included fever, pleural effusion, and partial splenic infarction.


SAE is considered a valuable adjunct to NOM in the treatment of blunt splenic injuries; however, risks of major and minor complications do exist, and SAE should be offered with caution and followed up appropriately.


Splenic Injury Compute Tomogram Splenic Infarction Splenic Abscess Splenic Artery Embolization 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Velmahos GC, Toutouzas KG, Radin R, et al. (2003) Nonoperative treatment of blunt injury to solid abdominal organs: a prospective study. Arch Surg 138:844–851PubMedCrossRefGoogle Scholar
  2. 2.
    Nix JA, Costanza M, Daley BJ, et al. (2001) Outcome of the current management of splenic injuries. J Trauma 50:835–842PubMedGoogle Scholar
  3. 3.
    Peitzman AB, Heil B, Rivera L, et al. (2000) Blunt splenic injury in adults: Multi-institutional Study of the Eastern Association for the Surgery of Trauma. J Trauma 49:177–189PubMedGoogle Scholar
  4. 4.
    Pachter HL, Guth AA, Hofstetter SR, et al. (1998) Changing patterns in the management of splenic trauma: the impact of nonoperative management. Ann Surg 227:708–719PubMedCrossRefGoogle Scholar
  5. 5.
    Papadimitriou J, Tritakis C, Karatzas G (1976) Treatment of hypersplenism by embous placement in the splenic artery. Lancet 11:1268–1170CrossRefGoogle Scholar
  6. 6.
    Stanley P, Shen TC (1995) Partial embolization of the spleen in patients with thalassemia J Vasc Interv Radiol 6:137–142PubMedGoogle Scholar
  7. 7.
    Sclafani SJ, Shaftan GW, Scalea TM, et al. (1995) Nonoperative salvage of computed tomography-diagnosed splenic injuries: utilization of angiography for triage and embolization for hemostasis. J Trauma 39:818–827PubMedGoogle Scholar
  8. 8.
    Davis KA, Fabian TC, Croce MA, et al. (1998) Improved success in non-operative management of blunt splenic injuries: embolization of splenic artery pseudoaneurysm. J Trauma 44:1008–1015PubMedGoogle Scholar
  9. 9.
    Hagiwara A, Yukioka T, Ohta S, et al. (1996) Nonsurgical management of patients with blunt splenic injury: efficacy of transcatheter arterial embolization. AJR Am J Roentgenol 167:159–166PubMedGoogle Scholar
  10. 10.
    Dent D, Alsabrook G, Erickson BA, et al. (2004) Blunt splenic injuries: high nonoperative management rate can be achieved with selective embolization. J Trauma 56:1063–1067PubMedGoogle Scholar
  11. 11.
    Haan JM, Bochicchio GV, Kramer N, et al. (2005) Nonoperative management of blunt splenic injury: a 5-year experience. J Trauma 58:492–498PubMedCrossRefGoogle Scholar
  12. 12.
    Omert LA, Salyer D, Dunham M, et al. (2001) Implications of the “contrast blush” finding on computed tomographic scan of the spleen in trauma. J Trauma 51:272–278PubMedCrossRefGoogle Scholar
  13. 13.
    Schurr MJ, Fabian TC Gavant M, et al. (1995) Management of blunt splenic trauma: computed tomographic contrast blush predicts failure of nonoperative management. J Trauma 39:507–513PubMedCrossRefGoogle Scholar
  14. 14.
    Benedict CN, Evan PN , Manuel PM, et al. (2004) Contrast extravasation predicts the need for operative intervention in children with blunt splenic trauma. J Trauma 56:537–541CrossRefGoogle Scholar
  15. 15.
    Shanmuganathan K, Mirvis S, Boyd-Kranis R, et al. (2000) Nonsurgical management of blunt splenic injury: use of CT criteria to select patients for splenic arteriography and potential endovascular therapy. Radiology 217:75–82PubMedGoogle Scholar
  16. 16.
    Haan J, Scott J, Boyd-Kranis RL, et al. (2001) Admission angiography for blunt splenic injury: advantages and pitfalls. J Trauma 51:1161–1165PubMedGoogle Scholar
  17. 17.
    Haan JM, Biffl W, Knudson MM, et al. (2004) Splenic embolization revisited: a multicenter review. J Trauma 56:542–547PubMedGoogle Scholar
  18. 18.
    Gaarder C, Dormagen JB, Eken T, et al. (2006) Nonoperative management of splenic injuries: improved results with angioembolization. J Trauma 61:192–198PubMedGoogle Scholar
  19. 19.
    Smith HE, Biffl WL, Majercik SD, et al. (2006) Splenic artery embolization: have we gone too far? J Trauma 61:541–544; discussion 545–546PubMedGoogle Scholar
  20. 20.
    Moore EE, Shackford SR, Pachter HL, et al. (1989) Organ injury scaling: spleen, liver and kidney. J Trauma 29:1664–1666PubMedGoogle Scholar
  21. 21.
    Ekeh AP, McCarthy MC, Woods RJ, et al. (2005) Complications arising from splenic embolization after blunt splenic trauma. Am J Surg 189:335–339PubMedCrossRefGoogle Scholar
  22. 22.
    Fang JF, Chen RJ, Lin BC, et al. (2003) Liver cirrhosis: an unfavorable factor for nonoperative management of blunt splenic injury. J Trauma 54:1131–1136PubMedCrossRefGoogle Scholar
  23. 23.
    Bessoud B, Denys A (2004) Main splenic artery embolization using coils in blunt splenic injuries: effects on the intrasplenic blood pressure. Eur Radiol 14:1718–1719PubMedCrossRefGoogle Scholar
  24. 24.
    Killeen KL, Shanmuganathan K, Boyd-Kranis R, et al. (2001) CT findings after embolization for blunt splenic trauma. J Vasc Interv Radiol 12:209–214PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2007

Authors and Affiliations

  • Shih-Chi Wu
    • 1
    • 2
  • Ray-Jade Chen
    • 2
  • Albert D. Yang
    • 3
  • Cheng-Cheng Tung
    • 1
  • Kun-Hua Lee
    • 1
  1. 1.Division of TraumaChanghua Christian HospitalChanghuaROC
  2. 2.Trauma and Emergency CenterChina Medical University HospitalTaichungROC
  3. 3.Division of RadiologyChanghua Christian HospitalChanghuaROC

Personalised recommendations