Gastroepiploic artery embolization for splenic trauma in a liver transplant recipient

Abstract

The spleen is a highly vascular organ susceptible to injury in blunt abdominal trauma, often leading to massive blood loss. Splenic artery embolization (SAE) has been shown to be a safe and effective nonoperative approach in cases of hemodynamically stable patients with blunt splenic trauma. SAE can be performed proximally or distally, with both approaches demonstrating similar clinical efficacy. This case report describes emergent splenic embolization for acute abdominal trauma in a liver transplant recipient. However, due to the presence of prior splenic artery ligation, a uniquely alternative route through the gastroepiploic artery was used to gain access to the spleen for embolization.

Keywords: Blunt abdominal trauma; gastroepiploic artery; liver transplant; splenic artery embolization.

Figure 1:

A 30-year-old male presented with chest and shoulder pain after motorcycle accident. (a-e) Axial CT slices demonstrate Grade V subcapsular splenic lacerations (green arrows) following blunt trauma with common hepatic artery (blue arrows) originating from celiac axis while splenic artery (yellow arrows) has been proximally ligated but still patent.

Figure 2:

A 30-year-old male presented with chest and shoulder pain after motorcycle accident. (a) Hypertrophied gastroepiploic artery (red arrows) anastomosing with distal splenic artery at splenic hilus seen on coronal CT slice. (b) Transplanted kidney (white arrow) seen on coronal CT slice. (c) Grade V subcapsular splenic lacerations (green arrows) seen on sagittal CT slice.

Figure 3:

A 30-year-old male presented with chest and shoulder pain after motorcycle accident. (a-d) Arteriography demonstrates dilated and tortuous GEA reaching until the splenic hilus (red arrows).

Figure 4:

A 30-year-old male presented with chest and shoulder pain after motorcycle accident. (a) Embolization using coaxial catheter (orange arrows)/microcatheter (purple arrows) system purposefully advanced close to splenic hilus to avoid needless embolization of gastric and superior pancreaticoduodenal segments arising from right GEA. (b-d) Contrast extravasation pre-embolization (black arrows), (e-f) no longer seen post-embolization (black circles).