Abstract :
A 34-year-old man was transferred from a local hospital to our trauma center after a motor
vehicle crash. He was diagnosed with a splenic laceration with bleeding (Figure 1). Multiple
rib fractures with hemopneumothorax, liver laceration, cervical vertebral fracture, and thoracic vertebral fracture were also diagnosed. His blood pressure was 114/74 mmHg and heart
rate was 110/min; he was intubated at the local hospital because of the lung injury. His vital
signs were stable but systolic blood pressure dropped progressively to 100 mmHg, therefore
splenic angiography was decided. No definite bleeding focus was identified, but venous or
parenchymal bleeding from spleen injury was suspected. Hence, diffusion of the gelfoam
particle embolization of the distal branch was performed to decrease the splenic perfusion
(Figures 2, 3). The next day, abdominal computed tomography (CT) revealed diffuse splenic
ischemia (Figure 4). The patient was stabilized and extubated. He complained of left chest
wall pain, but it could not be distinguished from the multiple rib fractures. He was moved to
the general ward and the other fracture site was treated with an orthosis. Eleven days postembolization, CT revealed splenic liquefaction (Figure 5). Because his condition was stable,
he was discharged and CT after 2 months showed atrophied spleen (Figure 6).
