COMBINED SPLENIC AND RENAL PRESERVATION THROUGH SURVEILLANCE ON-DEMAND EMBOLIZATION (SURV) IN SEVERE SPLENIC AND RENAL INJURY BY LOW-INTENSITY MECHANISM OF INJURY. sabrina919cb@gmail.com

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COMBINED SPLENIC AND RENAL PRESERVATION THROUGH SURVEILLANCE ON-DEMAND EMBOLIZATION (SURV) IN SEVERE SPLENIC AND RENAL INJURY BY LOW-INTENSITY MECHANISM OF INJURY.

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Mexico

Oral or Poster

Abdominal blunt trauma may result in complex solid organ injuries. In stable patients, angioembolization offers effective hemorrhage control while preserving organ function. This case describes its successful use in combined splenic and renal trauma.

Information is collected about a 22-year-old healthy male patient who sustained a fall of 4.92 ft onto a rock at the level of the left hemithorax. The patient was taken by private car to the emergency department 2 hours after the fall.

The patient was hemodynamically stable at his arrival to the emergency department, ATLS approach was initiated with the FAST exam in which perisplenic hematoma was identified. Toracoabdominal enhanced CT scan revealed a 10-arch fracture of the left ribs without displacement. Splenic injury grade III without contrast extravasation. CT also reveals a left kidney grade II injury. Initially, Non-operative management was decided, but the clinical course dictated to move forward to the angioembolization. Angiography reveals a left superior and inferior polar renal artery pyelocaliceal fistula. Splenic artery with no flush. Two days after the patient develops upper left quadrant abdominal pain, which moves us to a second angiography which shows 5 splenic pseudoaneurysm formation. An embolization of the supraselective splenic artery was done at the level of its intermediate and lower arterial segment, with endovascular coils.

Endovascular angioembolization allowed successful, organ-preserving management of complex splenic and renal injuries in a hemodynamically stable trauma patient, highlighting its value as a safe alternative to surgery.