Complications and recovery patterns after blunt splenic injury: Recommended duration and follow-up methods

BACKGROUND: Splenic artery embolization (SAE) is commonly employed as a non-operative management technique for splenic injury. Nonetheless, information on follow-up duration and methods, and the natural course of splenic infarction after SAE is limited. Thus, this study is aimed to analyze the patterns of complications and recovery of splenic infarction after SAE and to determine the appropriate follow-up duration and method. METHODS: Medical records of 314 patients with blunt splenic injury admitted at the Pusan National University Hospital, Level I Trauma Centre were analyzed to identify patients who underwent SAE between January 2014 and November 2018. Computed tomography (CT) scans that were obtained after SAE in patients who were followed up were compared with all their previous CT scans to identify any changes in the spleen and the occurrence of complications such as sustained bleeding, pseudoaneurysm, splenic infarctions, or abscess formation. RESULTS: Of the 314 patients, 132 who underwent SAE were included in the study. In total, 30 complications were noted among the 132 patients; of these, 7 (5.30%) required repeat embolization and 9 (6.82%) required splenectomy. Splenic infarction of <50% occurred in 76 patients and that of ≥50% including total and near-total infarctions occurred in 40 patients. Among patients with splenic infarction of ≥50%, 3 (2.27%) patients had abscesses between 16 and 21 days after SAE, and the range of infarctions increased as the AAAST-OIS grade increased. After SAE, repeat abdominal CT scans for >14 days were obtained in 75 patients; among these, 67 presented with recovery of splenic infarction. The median period of recovery was 43 days after SAE. CONCLUSION: The present findings suggest that patients with ≥50% infarction may need 3 weeks of closed observation, with or without a follow-up CT scan, to rule out infection after SAE, follow-up CT follow-up at 6 weeks after SAE may be necessary to confirm the recovery of the spleen.