Emorragia splenica post-traumatica in un adolescente:
il ruolo della angio-embolizzazione

The paper describes the case of a 13-year-old boy who arrived to the emergency room for 2 syncopal episodes associated with abdominal pain. Blood tests showed Hb 10.5 g/dl with normal MCV. His general medical conditions were regular except for a mild pain in the left upper quadrant due to abdominal trauma (a fall off the bicycle 10 days before). Laboratory tests revealed worsening anaemia: Hb 8.8 g/dl without signs of haemolysis. Abdominal ultrasound showed parenchimal haematoma (5 x 4 cm) and haemoperitoneum, CT confirmed this finding and also showed a focal hyperdensity that indicates active bleeding (American Association for the Surgery of Trauma grade IV). Angio-embolization with micro-spirals was performed because active bleeding with progressive anaemia was present. The haemoglobin growing trend and the stability of the ultrasound imaging confirmed the efficacy of the procedure. The angio-embolization is an established practice in adulthood. Its use in children is still discussed. It can be considered in selected cases, especially in adolescents, in order to avoid splenectomy.