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文献考察：１）TAEを積極的に行うことで保存的治療の成功例が増加する．
J Trauma. 2004 May;56(5):1063-7.
Blunt splenic injuries: high nonoperative management rate can be achieved with selective embolization.
Dent D, Alsabrook G, Erickson BA, Myers J, Wholey M, Stewart R, Root H, Ferral H, Postoak D, Napier D, Pruitt BA Jr.
BACKGROUND: This retrospective review tests the hypothesis that including selective splenic arteriography and embolization in the algorithm of a previously existing nonoperative management (NOM) strategy will result in higher rates of successful NOM in patients with blunt splenic injury. METHODS: All patients with blunt splenic injuries documented by computed tomographic scan and/or operative findings over a 24-month period at a Level I trauma center were reviewed. A previously published series from this institution of 251 patients with splenic injury (Group 1) was then compared with the patients that constitute this current review (Group 2). Group 2 was then compared with patients described in a previous publication advocating nonselective arteriography in blunt splenic injuries. RESULTS: Thirteen patients with blunt splenic injury in Group 2 underwent 14 splenic embolization procedures, with 12 (93%) being successfully treated without operation. Group 2 had a significantly higher NOM rate (82% vs. 65%, p
追記：脾臓損傷例の血管造影の適応．１．vascular（cotrast）blush（下記症例TR２の解答欄参照），２：持続する頻脈，３：低下し続けるヘマトクリット値．
文献考察：２）小児でも脾臓のpseudoaneurysmは塞栓術を施行すべき．
J Trauma. 2004 Aug;57(2):404-7.
Splenic artery embolization for post-traumatic splenic artery pseudoaneurysm in children.
Yardeni D, Polley TZ Jr, Coran AG.
Although rare, traumatic splenic artery pseudoaneurysm (SAP) can be life threatening. The diagnostic approaches as well as the methods of treatment of SAP are yet to be determined. We present the case of a 10-year-old boy treated conservatively for a grade III blunt splenic injury (BSI). The child was discharged to home after a 5-day uneventful hospitalization but was found on routine follow-up CT scan to have a large SAP. The pseudoaneurysm was successfully angiographically embolized and subsequent abdominal CT demonstrated successful resolution of the pseudoaneurysm with a small residual splenic cyst. We reviewed the eight cases of post-traumatic SAP in children that have been published in the English literature. Unlike SAP in adult patients, the severity of the splenic injury does not have predictive value for development of SAP in children. Abdominal pain was the most frequent symptom of SAP, but three children were asymptomatic at the time of diagnosis. Therefore, the possibility of SAP should be investigated even in the asymptomatic child with mild splenic injury. When a splenic pseudoaneurysm is diagnosed, we believe splenic artery embolization is indicated. PMID: 15345996
追記：脾臓損傷の保存的治療後の合併症率は成人で8％に，小児で7.5%に発生する．遅発性破裂，脾膿瘍，嚢疱形成と脾動脈仮性動脈瘤など．8例の集計・検討で2例はgrade Iで発生しており，gradeに関係なく外傷後3ヶ月間は腹部エコーによるfollow-upが必要である．小児の脾動脈仮性動脈瘤は自然閉塞する症例も少なくないが，安全に行えるので塞栓術を行うべきと著者らはいう.
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