Can we predict delayed undesirable events after blunt injury to the torso visceral organs?

Abstract

Aim: Blunt injuries to visceral organs have the potential to lead to delayed pseudoaneurysm formation or organ rupture, but current trauma and surgical guidelines do not recommend repetitive imaging. This study examined the incidence and timing of delayed undesirable events and established advisable timing for follow-up imaging and appropriate observational admission.

Methods: Patients with blunt splenic (S), liver (L), or kidney (K) injury treated with non-operative management (NOM) in our institution were included and retrospectively reviewed.

Results: From January 2013 to January 2017, 57 patients were admitted with documented blunt visceral organ injuries and 22 patients were excluded. Of 35 patients (L, 10; S, 17; K, 6; L & S, 1; S & K, 1) treated with NOM, 14 (L, 4; S, 9; K, 1) patients underwent transcatheter arterial embolization. Delayed undesirable events occurred in four patients: three patients with splenic pseudoaneurysm on hospital day 6-7 and one patient with splenic delayed rupture on hospital day 7. The second follow-up computed tomography scan carried out 1-2 days after admission did not show any significant findings that could help predict undesirable results of delayed events. The patients with delayed events had longer continuous abdominal pain than that of event-free patients (P = 0.04).

Conclusions: Undesirable delayed events were recognized on follow-up computed tomography scans in 11.4% of NOM patients at hospital day 6-7 and tended to be associated with high-grade splenic injuries and continuous symptoms. Repetitive screening of these patients 6-7 days after injury might be warranted because of the potential risk of delayed events.

Keywords: Blunt trauma; delayed rupture; non‐operative management; pseudoaneurysm.

Figure 1

Of 57 patients with blunt visceral organ injury, 18 patients treated with immediate laparotomy were excluded from the study. Four patients with severe brain injury or spinal or pelvis injury who needed continuous bedrest were also excluded. The remaining 35 patients treated with non‐operative management (NOM) were included in this study. GCS, Glasgow Coma Scale; TAE, transcatheter arterial embolization.