PURPOSE:Radiologist plays an integral role in the conservative management of ongoing internal bleeding following trauma. The purpose of this study was to analyze the outcome of conservative management in patients with internal arterial bleeding from the abdominal organs as well as the chest after sustaining multiple injuries.
METHODS:Demographics, clinical information, computed tomography (CT) scans and angiograms were retrospectively reviewed from the prior 5 years. Included in the study were all the patients who underwent CT scan followed by angiogram. Extravasations of contrast on CT scan was considered positive for ongoing internal arterial bleeding. Angio-embolization was performed with positive findings on angiography.
RESULTS:Eighty nine consecutive patients were included in the study. Of the 89 patients, 46 patients had one or more organ system injuries requiring embolization. Five out of 46 (11%) patients underwent surgery after failure of non-operative management including one mortality with multiple sites of extravasations. Two out of five failures were due to splenic injury and three failures were seen in patients with hepatic injuries which included one patient with multiple sites of extravasations. The distribution of angiograms and embolizations were respectively: spleen 34.3% and 34.8%, pelvic vessels 22.2% and 23.9%, liver 18.5% and 19.6%, renal and adrenal 13.9% and 10.9% and others 10.4% and 10.9%.
CONCLUSION:The study showed that initial contrast CT scan followed by angiogram and, angio-embolisation has a very high success rate of conservative management across the injury spectrum.
CLINICAL IMPLICATIONS:Prompt use of angioembolization is the key of success of conservative management in patients with internal bleeding following torso trauma.
DISCLOSURE:Daniel Kassavin, No Financial Disclosure Information; No Product/Research Disclosure Information