Blunt traumatic dissection of the celiac artery without aortic dissection is a rare event. There is paucity of data on the appropriate management of such injuries. In this brief report, we present a patient with isolated celiac artery dissection after blunt abdominal trauma. The patient was managed non-operatively with anticoagulation and developed splenic infarct. Due to its rarity, no grading criteria and management guidelines exist for the spectrum of isolated blunt CA injuries. Furthermore, it remains unlikely that injury volume will increase to create robust management guidelines. We therefore suggest that isolated celiac artery injury be graded based on the Biffl grading criteria for blunt cerebrovascular injury and managed accordingly.

Background: There is a global surge in blast injuries, which are associated with high morbidity and mortality. To our knowledge, there are no guidelines for the management of blast injuries in the trauma bay.Methods: This single-center retrospective cohort study utilized data on all patients admitted to our emergency department (ED) with terror- or combat-related injuries between October 7, 2023 (Gaza Iron Swords War onset) and February 4, 2024. The primary outcome was trauma severity indicated by either an injury severity score (ISS) >15 and/or need for acute care. We also analyzed the mechanisms of injuries, focusing on those resulting from blasts.Results: Of 208 patients who were admitted following terror-and combat related injuries, 109 patients (101 males [93%], median age 24.0 years) were admitted following blast injuries. Of them, 88% were military personnel and 12% were civilians, with a median ISS of 8 [IQR:4.0-17.0]. The level of trauma was severe in 48 patients (44%). Tertiary sub-category of blast injuries (P=0.004), chest (P=0.032), abdomen (P=0.018), and lower extremities (P=0.044) injuries were significantly associated with severe trauma. Blast injuries mandated the urgent availability of specialist personnel and appropriate equipment to contend with multiple life-threatening sequelae of exposure to blasts upon the arrival of the victims to emergency services.Conclusion: Blast injuries present unique challenges in management and demand a multidisciplinary approach and specialized resources. We present an algorithm for terror- and combat-related blast injuries treated in our trauma bay. The step-by-step procedures may be applicable to any blast injury sustained under variable conditions.

Cardiac injury remains a small percentage of trauma patients being received at trauma centers, despite a continual improvement in prehospital care and an unfortunate increase in penetrating trauma over the last few years. There are major differences between penetrating and blunt cardiac injury (BCI) in the presentation of the patient to the trauma bay, associated injuries, diagnostic methods, and therapeutic interventions. Depending on the mechanism of injury and management of these patients, low mortality is obtainable. There is clear evidence for those needing continuous monitoring when arrhythmia is present in the emergency room and/or cardiac enzymes are abnormal. For patients without these findings, there is no evidence for the need for continuous ECG monitoring. There are multiple approaches and techniques to treat a foreign body in the heart, depending on the characteristics of the impaled or retained object and the resources available at the hospital.

Introduction Numerous surgical approaches and hemostatic techniques are used and have been described when operating on the traumatized liver. Despite a substantial decline in operative liver trauma, there still remains a debate on the optimal surgical approach, and goals, during the initial trauma laparotomy. Hepatic resection during the first operation, including the damage control settings, is advocated and practiced in only a select few institutions and remains highly controversial. Here, we describe our success with hepatic resection, repair, and/or hepatic vascular repair, during the trauma laparotomy with our emphasis on the collaboration between the trauma and hepatobiliary surgical teams. Case Series From 207 patients with liver injuries during the study period, 7 patients had definitive liver resection or repair during the initial trauma laparotomy. One had hepatic tissue repair, 1 had hepatic vein repair, and 5 had liver resections. All the operations involved a hepatobiliary surgeon together with the trauma team. There were no fatalities in the liver operation group, no sepsis, or need for emergent angiography because of hemorrhage. Four patients needed endoscopic retrograde cholangiopancreatography (ERCP) and stenting because of biliary leak. Three patients were discharged home and 4 to rehabilitation. Discussion Hepatic resection, and/or definitive hepatic repair, may be safe and beneficial to the patients during the initial operation even in a damage control setting when the patients’ overall condition allows. We emphasize the benefit of collaboration with experienced and trained liver surgery, especially in lower volume trauma centers. ERCP is commonly needed for postoperative biliary leak and should be readily utilized.

Background: Recent studies noted the limited applicability of Glasgow Coma Scale (GCS) for elderly patients with Traumatic Brain Injury (TBI). However, the dichotomic distinction between "elderly" and "non-elderly" does not cover the full span of influence of age on GCS presentation.Objective: To analyze the influence of age on GCS scores of patients with isolated TBI.Methods: A retrospective study of 18,534 patients hospitalized due to isolated TBI recorded in the Israeli National Trauma Registry in 1997-2017. The GCS scores were compared between four age-groups: 20-44, 45-64, 65-74 and 75+ years old. Additional factors included patient's sex, Abbreviated Injury Scores (AIS) and injury circumstances.Results: GCS scores increased continuously with age at all AIS levels. The trend was significant even after adjustment for patient's sex and injury circumstances. The angle of the trend was different in various injury circumstances, with GCS scores of victims of Road Traffic Accidents sharply increasing after age of 44 and that of the patients hospitalized after falling from own height surging after age of 64.Conclusions: Screening procedures for patients with TBI should give a greater weight to the actual age of adults, as well as to the circumstances of their injury.

Objective: To compare demographic, injury and hospitalization characteristics and mortality between Isolated and Non-Isolated traumatic brain injury. Methods: A retrospective study based on the Israeli National Trauma Registry of patients hospitalized for traumatic brain injury (TBI) between 2008 and 2016. Isolated TBI was defined as no other anatomic region was having concomitant injury with AIS >= 2. X-2 test and multivariate logistic regression analysis were used for data analysis. Results: Of the 23566-study population, 40.4% were admitted for isolated TBI. Isolated TBI was significantly more frequent in elderly aged >= 65 years, female, Jews, and injuries sustained at home or in residential institution. The Non-isolated TBI was greater in road traffic injuries, particularly among pedestrians and motor cyclists, and in violence injuries. The Non-isolated TBI group had greater injury severity and hospital resource utilization. In-hospital mortality was higher in the patients with Non-isolated TBI [OR: 1.56(95% CI: 1.33-1.83)], particularly in patients with GCS 13-15; elderly aged 65+ years; and patients with concomitant injuries to abdomen, spine or external body regions. Conclusion: In a patient with TBI, concomitant injuries with AIS >= 2 matter, and awareness of the identified factors has relevance for guiding injury prevention efforts and indeed for potentially improving care and outcome.

Introduction: Bus public transportation is preferred for its perceived safety. Data from several countries, however, alarm of non-collision injuries associated with bus use. The aim of the current study was to estimate the prevalence of non-collision bus injuries, and compare and identify population group at high risk for severe injuries, to serve as a basis for policy makers. Methods: A retrospective analysis of the Israeli National Trauma Registry cohort for the years 2015-2017 was carried out. Database consists of 20 hospitals nationwide. Casualties hospitalized following a non-collision injury on a bus were identified. Demographic, injury characteristics, and hospital resources utilization were compared according to the place of injury; inside the bus or during boarding or alighting. Results: During follow up, 704 hospitalized non-collision related bus casualties were recorded. Most of the casualties (75%) fell inside the bus and 25% during boarding or alighting. The majority (67%) of hospitalized patients were 60 years old or above, mostly injured while boarding or alighting the bus, and 72% were women. Frequent injured body regions were lower extremities, head and torso. Passengers injured inside bus sustained more chest injuries, but less lower extremities injuries, compared to those boarding or alighting the bus. More hospital resources were required to treat passengers injured while boarding or alighting the bus. Conclusions: This systematic registry-based analysis of non-collision bus injuries confirms the greater risk of being injured while using bus transportation among women and older passengers. Primary attention for prevention policies should be given to injuries occurring during boarding or alighting of the bus. Additional policy recommendations are discussed.

Despite the demographic minority of children in any given population, mass casualty incidents (MCI) often impact areas with a high concentration of children, such as schools and recreational events. Even those MCI primarily involving children are initially met by healthcare workers trained to provide care for adults (from the first-response team to the specialty physicians), as well as an infrastructure designed for triaging, transporting, and treating adult patients.

Objective: To evaluate and compare, at the national level, injury trends and, characteristics and to identify high risk groups of electric bike (E-bike) and mechanical bicycle (M-bike) related hospitalizations as a key message for public policy. Methods: Historic prospective study based on data from the Israel National Trauma Registry (INTR), between 1.1.2013 and 31.12.2017. All hospitalized casualties were E-bikers and M-bikers. Results: During the study period, 1733 E-bikers and 7259 M-bikers were hospitalized. Arab children (age 0-15) and young adults (age 16-29) were at higher risk for E-bike and M-bike casualties respectively. The hospitalization rate per 1000 vehicles was lower for E-bikers in comparison to M-biker. However, during the five year period a dramatic increase in E-bike related hospitalizations was reported coinciding with a decrease of M-bike related casualties. Among M-bikers, the decrease in hospitalization rate was for accidents on both inter and intracity roads, but not on unpaved roads, which remained stationary, suggesting that the transportation mode is changing. In comparison to the M-bikers, E-bikers were at greater risk for enduring head injuries (OR 1.16 95% CI 1.00-1.25) and lower extremity injuries (OR 1.37 95% CI 1.23-1.52), to undergone surgery (OR 1.13 95% CI 1.00-1.26), having longer hospital stays (OR 1.44 95% CI 1.23-1.68) and being discharged to rehabilitation center (OR 1.43 95% CI 1.09-1.86). Conclusion: During the last five years in Israel there is a dramatic increase in E-bike related hospitalized casualties corresponding to a substantial increase in E-bike usage. In comparison to M-bikers, there is a lower casualty rate but these casualties are more severely injured and utilize more hospital resources. It is of utmost importance to identify these high risk groups in an effort to develop culturally appropriate interventions for these road users, including training, awareness and helmet enforcement. Policy change recommendations are discussed.

From the Department of General Surgery (A.L.S.), Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; and The Yitzhak Rabin Trauma Division (D.S.), Department of General Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. Submitted: October 21, 2016, Revised: June 22, 2017, Accepted: July 4, 2017, Published online: August 7, 2017. Address for reprints: Adam Lee Goldstein, MD, Department of Surgery, Tel Aviv Sourasky Medical Center, 4th Floor Medical Tower, 6 Weizmann St., Tel Aviv, Israel 64239; email: [email protected].

AIM:To assess the incidence and injury characteristics of hospitalized trauma patients diagnosed with TBI.METHODS:A retrospective study of all injured hospitalized patients recorded in the National Trauma Registry at 19 trauma centres in Israel between 2002-2011. Incidence and injury characteristics were examined among children, adults and seniors.RESULTS:The annual incidence rate of hospitalized TBI for the Israeli population in 2011 was 31.8/100,000. Age-specific incidence was highest among seniors with a dramatic decrease in TBI-related mortality rate among them. Adults, in comparison to children and seniors, had higher rates of severe TBI, severe and critical injuries, more admission to the intensive care unit, underwent surgery, were hospitalization for more than 2 weeks and were discharged to rehabilitation. After adjusting for age, gender, ethnicity, mechanism of injury and injury severity score, TBI-related in-hospital mortality was higher among seniors and adults compared to children.CONCLUSION:Seniors are at high risk for TBI-related in-hospital mortality, although adults had more severe and critical injuries and utilized more hospital resources. However, seniors showed the most significant reduction in mortality rate during the study period. Appropriate intervention programmes should be designed and implemented, targeted to reduce TBI among high risk groups.

BackgroundTerrorist explosions occurring in varying settings have been shown to lead to significantly different injury patterns among the victims, with more severe injuries generally arising in confined space attacks. Increasing numbers of terrorist attacks have been targeted at civilian buses, yet most studies focus on events in which the bomb was detonated within the bus. This study focuses on the injury patterns and hospital utilisation among casualties from explosive terrorist bus attacks with the bomb detonated either within a bus or adjacent to a bus.MethodsAll patients hospitalised at six level I trauma centres and four large regional trauma centres following terrorist explosions that occurred in and adjacent to buses in Israel between November 2000 and August 2004 were reviewed. Injury severity scores (ISS) were used to assess severity. Hospital utilisation data included length of hospital stay, surgical procedures performed, and intensive care unit (ICU) admission.ResultsThe study included 262 victims of 22 terrorist attacks targeted at civilian bus passengers and drivers; 171 victims were injured by an explosion within a bus (IB), and 91 were injured by an explosion adjacent to a bus (AB). Significant differences were noted between the groups, with the IB population having higher ISS scores, more primary blast injury, more urgent surgical procedures performed, and greater ICU utilisation. Both groups had percentages of nearly 20% for burn injury, had high percentages of injuries to the head/neck, and high percentages of surgical wound and burn care.ConclusionsExplosive terrorist attacks detonated within a bus generate more severe injuries among the casualties and require more urgent surgical and intensive level care than attacks occurring adjacent to a bus. The comparison and description of the outcomes to these terrorist attacks should aid in the preparation and response to such devastating events.

Background: According to the World Health Organization, over one million people die annually from traffic crashes, in which over half are pedestrians, bicycle riders and two-wheel motor vehicles. In Israel, during the last decade, mortality from traffic crashes has decreased from 636 in 1998 to 288 in 2011. Professionals attribute the decrease in mortality to enforcement, improved infrastructure and roads and behavioral changes among road users, while no credit is given to the trauma system. Trauma systems which care for severe and critical casualties improve the injury outcomes and reduce mortality among road casualties.Goals: 1) To evaluate the contribution of the Israeli Health System, especially the trauma system, on the reduction in mortality among traffic casualties. 2) To evaluate the chance of survival among hospitalized traffic casualties, according to age, gender, injury severity and type of road user.Methods: A retrospective study based on the National Trauma Registry, 1998-2011, including hospitalization data from eight hospitals.Outcomes: During the study period, the Trauma Registry included 262,947 hospitalized trauma patients, of which 25.3% were due to a road accident. During the study period, a 25% reduction in traffic related mortality was reported, from 3.6% in 1998 to 2.7% in 2011. Among severe and critical (ISS 16+) casualties the reduction in mortality rates was even more significant, 41%; from 18.6% in 1998 to 11.0% in 2011. Among severe and critical pedestrian injuries, a 44% decrease was reported (from 29.1% in 1998 to 16.2% in 2011) and a 65% reduction among bicycle injuries. During the study period, the risk of mortality decreased by over 50% from 1998 to 2011 (OR 0.44 95% 0.33-0.59. In addition, a simulation was conducted to determine the impact of the trauma system on mortality of hospitalized road casualties. Presuming that the mortality rate remained constant at 18.6% and without any improvement in the trauma system, in 2011 there would have been 182 in-hospital deaths compared to the actual 108 traffic related deaths. A 41% difference was noted between the actual number of deaths and the expected number.Conclusions: This study clearly shows that without any improvement in the health system, specifically the trauma system, the number of traffic deaths would be considerably greater. Although the health system has a significant contribution on reducing mortality, it does not receive the appropriate acknowledgment or resources for its proportion in the fight against traffic accidents.

Necrotizing fasciitis (NF) in trauma patients has the detrimental potential for a delayed diagnosis as a result of the distraction of the primary injuries. Like with all trauma patients, the details of the mechanism of trauma are important to best plan appropriate diagnostic studies and emergent care. This brief report shows an example of how a history of exposure to fresh water during the initial traumatic event provided a significant clue into the causative agent behind the NF seen in this patient within days after a traumatic incident. We report a distinct form of NF caused by the Gram-negative Aeromonas bacterium after the wound site was exposed to fresh water during a motorcycle accident. This brief report focuses on how Aeromonas hydrophilia causes an atypical presentation of NF and the importance of aggressive surgical treatment without delay to prevent fatality. A healthy 39-year-old man was the helmeted driver of a 124-horsepower motorcycle traveling approximately 90 kmh involved in an accident on a Tel Aviv highway. The driver was ejected approximately 12 m into the muddy waters of the Ayalon River between the highway and railroad tracks. An ambulance team was the first to arrive at the scene of the accident where the victim was found lying face-up in the water without airway obstruction. His motorcycle was found to be lightly damaged and his helmet was intact. The patient was alert, appropriately oriented, without the initial presentation of significant bleeding or body deformities. At arrival to our emergency department, the patient was not acutely distressed with a Glasgow Coma Scale of 15, systolic blood pressure of 103 mmHg, pulse of 87 beats/min, a respiratory rate of 30 breaths/min, and an SaO2 level at 98 per cent on 10 L/min of supplementary oxygen. His airway was clear without obstruction. Auscultation of the lungs revealed normal breath sounds bilaterally. Inspection of his chest wall was negative for contusions, lacerations, abrasions, or deformities. Palpation of the rib cage showed tenderness bilaterally without instability. His abdomen was not tender, not distended, without hepatosplenomegaly or palpable pulsations. His upper extremities and right leg were without signs of trauma or motor/sensory/circulatory deficits. Swelling and tenderness were found at the left border of his pubis. Gentle pressure to his pelvic bone was without instability. His proximal left leg from the hip flexure to the midfemur was swollen and tender without an open fracture or neurovascular compromise to the distal limb. The distal thoracic spine was tender on palpation. Rectal examination was normal. The patient’s chief complaint was of a sharp pain in his left leg. The routine laboratory tests were within the normal range. The patient proceeded with a computed tomography scan as a result of the mechanism of the trauma, tachypnea, and multiple skeletal abnormal findings on physical examination. The head computed tomography (CT) scan was normal. The chest CT scan revealed small bilateral pneumothorax and lung contusions and right-sided rib fractures of ribs 3 to 12 and ribs 5 to 11 on the left. There was a ‘‘chance fracture’’ of the T12 vertebra with protrusion of bony fragments into the spinal canal. Abdominal CT was negative. The pelvic CT showed a fracture of his left acetabulum, ilium, and pubis without evidence of visceral injury or free fluid in the abdomen or pelvis. Multiple roentgenogram studies of his left lower limb showed a midshaft fracture of the femur, bimalleolar fractures, and dislocation of the ankle. The patient was transferred to the intensive care unit. Shortly on admission, his respiratory and hemodynamic status deteriorated. A repeat chest radiograph revealed a significant right pleural effusion. A chest tube was placed, which immediately drained 700 mL of blood. After adequate blood products and fluid resuscitation, the patient stabilized. Address correspondence and reprint requests to Adam Lee Goldstein, M.D., Division of General Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel. E-mail: adamg.barefoot@gmail.com.

Israel is a small country with a unique trauma system that was developed from the experience gained in peace and in war. That trauma system was designed to fit the state's current health system, which is different from the European and American systems. This article describes the infrastructure of both prehospital and in-hospital trauma management, as well as the main cornerstones of their development. The experience that was gained from multiple mass casualty incidents is discussed. The protocols of mass casualty management in the prehospital and in-hospital setup are described.

Post-operative delirium is common, and has an incidence of 37-74% as reported in different publications. The growing rates of the elderly among surgical patients makes that condition more relevant than ever, since these populations are highly susceptible to develop this condition. Contrary to the common assumption, delirium is not a unique complication of the elderly alone. Trauma and young surgical patients may also present its manifestations after major and complicated surgery in the different intensive care units. Post-operative delirium was shown to precede long term complications such as dementia. Many of the patients that develop delirium will be sent to long and complicated rehabilitation units, after being reLeased from hospitalization, thus increasing the economic burden on the medical system. Furthermore, the once recognized "ICU Psychoses" are no longer exclusive to intensive care units alone, and nowadays, infiltrate to all surgical departments. Simple, bedside clinical tools were developed, for rapid diagnoses of post-operative delirium. Adequate and on time diagnosis of this condition is crucial in the surgical patient, as it may be the only sign that predicts other severe surgical complications. This review exposes aspects of post-operative delirium in the elderly patient. Diagnostic modalities, as well as current management recommendations are discussed.

METHODS:We conducted a prospective, representative-sample nationwide study on morbidity related to 3,4, methylenedioxymethamphetamine (MDMA; 'ecstasy') as determined from admissions to 5 geographically representative emergency departments (EDs) and from data from the poison information center (PIC). MDMArelated ED admissions were analyzed over a 7-month period and the records of all PIC calls were reviewed.RESULTS:There were 52 (age 15-44 years, 32 males) ecstasy-related ED admissions during the study period. Most (68%) admissions presented to the ED at night, 52% on weekends and 44% consumed the drug at clubs and parties. Forty-six percent of the patients took between 1/2 to 3 tablets and 29 patients (56%) had taken ecstasy before. Twenty-two subjects (42%) reported poly-drug use. Fifteen subjects (29%) required hospitalization, six of them (11%) to the intensive care unit. The most common manifestations were restlessness, agitation, disorientation, shaking, high blood pressure, headache and loss of consciousness. More serious complications were hyperthermia, hyponatremia, rhabdomyolysis, brain edema and coma.CONCLUSION:The image of ecstasy as a safe party drug is spurious. The results of this study confirm that the drug bears real danger of physical harm and of behavioral, psychological and psychiatric disturbances.

The type and need for follow-up of non-operatively managed blunt splenic injuries remain controversial. The use of Doppler ultrasound to identify post-traumatic splenic pseudoaneurysms, considered to be the main cause of “delayed” splenic rupture, has not been well described.

PurposeEmbolotherapy had been incorporated into the care of splenic injury almost 20 years ago. Embolization was often performed as selectively as possible. In proximal embolization, the treatment goal is a decrease in the splenic blood pressure, rather than a complete stop of blood flow to the spleen. Splenic ischemia is prevented by preserved collateral flow. As the concept of proximal embolization is gaining broader acceptance, indications for the procedure are also evolving. Those currently include patients with CT suggestive of active bleeding and some high surgical risk hemodynamically unstable patient, in addition to hemodynamically stable patients with grade III-V (AAST guidelines) splenic injury. We describe our experience with proximal embolization of the splenic artery as a treatment for patients with splenic trauma.Materials and Methods25 patients underwent proximal splenic artery embolization at our institution between December 04 and July 09, until January 09 as part of a prospective observational study and thereafter according to clinical guidelines. Clinical and Doppler examinations were performed to assess clinical outcome, splenic blood flow, and the occurrence of complications such as pseudoaneurysms, infarcts or abscesses formation. Angiographic studies, procedure data and follow up information were reviewed.Results25 patients with blunt abdominal trauma and CT evidence of either high grade injury or active splenic bleeding were treated by proximal splenic artery embolization. Embolization was achieved by coils in 20 cases and by Amplatzer occluder in 5 cases. No patient underwent repeated embolization or surgery. 23 patients (92%) completed the Doppler evaluation. Preserved splenic blood flow was found in 95% of them. No pseudoaneurysms were demonstrated. Peri-splenic collection were found in 2 patient (8%) and responded well to percutaneous drainage.ConclusionIn this series, proximal splenic artery embolization was effective in controlling bleeding while allowing preservation of the spleen. The procedure was technically feasible in all attempted cases. There were minimal complications according to clinical and Doppler assessments. PurposeEmbolotherapy had been incorporated into the care of splenic injury almost 20 years ago. Embolization was often performed as selectively as possible. In proximal embolization, the treatment goal is a decrease in the splenic blood pressure, rather than a complete stop of blood flow to the spleen. Splenic ischemia is prevented by preserved collateral flow. As the concept of proximal embolization is gaining broader acceptance, indications for the procedure are also evolving. Those currently include patients with CT suggestive of active bleeding and some high surgical risk hemodynamically unstable patient, in addition to hemodynamically stable patients with grade III-V (AAST guidelines) splenic injury. We describe our experience with proximal embolization of the splenic artery as a treatment for patients with splenic trauma. Embolotherapy had been incorporated into the care of splenic injury almost 20 years ago. Embolization was often performed as selectively as possible. In proximal embolization, the treatment goal is a decrease in the splenic blood pressure, rather than a complete stop of blood flow to the spleen. Splenic ischemia is prevented by preserved collateral flow. As the concept of proximal embolization is gaining broader acceptance, indications for the procedure are also evolving. Those currently include patients with CT suggestive of active bleeding and some high surgical risk hemodynamically unstable patient, in addition to hemodynamically stable patients with grade III-V (AAST guidelines) splenic injury. We describe our experience with proximal embolization of the splenic artery as a treatment for patients with splenic trauma. Materials and Methods25 patients underwent proximal splenic artery embolization at our institution between December 04 and July 09, until January 09 as part of a prospective observational study and thereafter according to clinical guidelines. Clinical and Doppler examinations were performed to assess clinical outcome, splenic blood flow, and the occurrence of complications such as pseudoaneurysms, infarcts or abscesses formation. Angiographic studies, procedure data and follow up information were reviewed. 25 patients underwent proximal splenic artery embolization at our institution between December 04 and July 09, until January 09 as part of a prospective observational study and thereafter according to clinical guidelines. Clinical and Doppler examinations were performed to assess clinical outcome, splenic blood flow, and the occurrence of complications such as pseudoaneurysms, infarcts or abscesses formation. Angiographic studies, procedure data and follow up information were reviewed. Results25 patients with blunt abdominal trauma and CT evidence of either high grade injury or active splenic bleeding were treated by proximal splenic artery embolization. Embolization was achieved by coils in 20 cases and by Amplatzer occluder in 5 cases. No patient underwent repeated embolization or surgery. 23 patients (92%) completed the Doppler evaluation. Preserved splenic blood flow was found in 95% of them. No pseudoaneurysms were demonstrated. Peri-splenic collection were found in 2 patient (8%) and responded well to percutaneous drainage. 25 patients with blunt abdominal trauma and CT evidence of either high grade injury or active splenic bleeding were treated by proximal splenic artery embolization. Embolization was achieved by coils in 20 cases and by Amplatzer occluder in 5 cases. No patient underwent repeated embolization or surgery. 23 patients (92%) completed the Doppler evaluation. Preserved splenic blood flow was found in 95% of them. No pseudoaneurysms were demonstrated. Peri-splenic collection were found in 2 patient (8%) and responded well to percutaneous drainage. ConclusionIn this series, proximal splenic artery embolization was effective in controlling bleeding while allowing preservation of the spleen. The procedure was technically feasible in all attempted cases. There were minimal complications according to clinical and Doppler assessments. In this series, proximal splenic artery embolization was effective in controlling bleeding while allowing preservation of the spleen. The procedure was technically feasible in all attempted cases. There were minimal complications according to clinical and Doppler assessments.