Traumatic Splenic Artery Pseudoaneurysm Managed With Percutaneous Histoacryl (N-butyl-2-cyanoacrylate) Embolization: An Alternative to the Conventional Transcatheter Approach.

BACKGROUND Traumatic splenic artery pseudoaneurysm (SAP) can initially be asymptomatic, but it is a high-risk, contained arterial rupture that can progress to delayed abdominal pain and bleeding, with a significant mortality rate if untreated. In hemodynamically stable patients, embolization is usually the first-line treatment, although conventional transcatheter approaches may not always be feasible. We present a case of pediatric trauma treated with an ultrasound-guided percutaneous approach to perform histoacryl (N-butyl-2-cyanoacrylate) embolization, with satisfactory outcome. We further briefly explore the current state of the literature regarding the approaches and choices of embolic agents for pseudoaneurysm embolization. CASE REPORT A previously healthy 10-year-old boy was hospitalized after a 1.5-meter fall causing blunt abdominal trauma. He presented with left-sided abdominal pain and vomiting. Initial ultrasound studies showed splenic laceration. He was initially managed conservatively. Subsequent ultrasound 2 weeks post-injury showed a splenic pseudoaneurysm which was later confirmed on computed tomography. The decision was made for embolization due to persistence of the pseudoaneurysm over a 2-week interval. Catheter angiography did not clearly delineate the pseudoaneurysm. However, since it was demonstrated on ultrasound, the decision was made to employ direct percutaneous access. Histoacryl was then injected to occlude the inflow and the pseudoaneurysm sac. Embolization was successfully performed with an uneventful recovery. The patient remained well at the 6-month follow-up; the latest ultrasound showed that the splenic pseudoaneurysm remained completely thrombosed. CONCLUSIONS Traumatic SAP, albeit uncommon, should be promptly recognized and treated due to the substantial risk of hemorrhage. Our case demonstrates that a percutaneous approach is a viable alternative embolization technique when the conventional transcatheter approach fails.