Can Splenic Embolization Cause Ileus?
Yes, splenic embolization can cause ileus as part of post-embolization syndrome (PES), which occurs in up to 90% of pediatric patients and is also seen in adults, though the syndrome is typically self-limited and resolves within 6-9 days. 1
Post-Embolization Syndrome: The Primary Mechanism
Post-embolization syndrome is a well-recognized complication following splenic artery embolization that includes ileus as a core component. The syndrome consists of: 1
- Abdominal pain
- Nausea
- Ileus (the specific concern in your question)
- Fever
Clinical Course and Prognosis
The ileus associated with splenic embolization has favorable characteristics: 1
- Self-limited: Resolves spontaneously without intervention in most cases
- Duration: Typically resolves within 6-9 days
- Incidence: Occurs in approximately 90% of pediatric patients undergoing angiography/angioembolization (AG/AE)
- Mortality: Rarely associated with major complications or death
Additional Complications to Monitor
While ileus is part of the expected post-embolization syndrome, clinicians should remain vigilant for other complications: 1
- Pleural effusion (9% incidence)
- Pneumonia (9% incidence)
- Coil migration (4.5% incidence)
- Splenic abscess 2, 3
- Splenic infarction 2, 3
- Contrast-induced renal insufficiency 2, 3
Clinical Management Approach
When ileus develops after splenic embolization: 1
- Expect it: Recognize that ileus is part of the normal post-procedure course in the majority of patients
- Conservative management: Supportive care is typically sufficient given the self-limited nature
- Timeline: Anticipate resolution within 6-9 days
- Red flags: Investigate for alternative diagnoses if symptoms persist beyond this timeframe or worsen significantly
Important Caveats
The evidence base for post-embolization syndrome comes primarily from pediatric trauma populations, though the syndrome is recognized in adults as well. 1 The World Society of Emergency Surgery guidelines specifically note that mortality and major complications are rarely reported following AG/AE, positioning ileus as an expected but benign complication rather than a serious adverse event. 1
Distal embolization techniques are associated with higher complication rates (24% vs 6% for proximal embolization alone), though this primarily refers to major complications like abscess and infarction rather than post-embolization syndrome specifically. 2