A case report of splenic artery embolization after delayed presentation following blunt abdominal trauma, complicated by multiple large splenic artery pseudoaneurysms

Background: Splenic laceration is the most common injury following blunt abdominal trauma. Injury is characterised by the presence of parenchymal laceration however vascular lesions may also be seen such as pseudoaneurysms. Multiple pseudoaneurysms are a particularly rare complication. Delayed treatment is traditionally with splenectomy however small case series of the use of embolization have been described. Case presentation: A 29-year-old lady presented with left upper quadrant pain 22 days after a motor vehicle accident; she was hemodynamically stable. Computed tomography imaging with contrast enhancement demonstrated AAST grade IV splenic artery injury with multiple large splenic artery pseudoaneurysms. The patient proceeded to angiography and was treated with proximal coil embolization. Ultrasound demonstrated pseudoaneurysm thrombosis at 4 days and again at 6 weeks after treatment. Conclusion: This case demonstrates the success of splenic artery embolization in achieving non-operative management of blunt splenic injury in a sub-acute setting, even with the presence of multiple large splenic artery pseudoaneurysms.