Delayed splenic rupture: A true entity

doi:10.1016/S0009-9260(84)80201-9

Clinical Radiology

Volume 35, Issue 5, January–November 1984, Pages 393-396

https://doi.org/10.1016/S0009-9260(84)80201-9 Get rights and content

Two cases of secondary haemorrhage into subcapsular haematomas with delayed splenic rupture are presented. Ultrasound and computed tomography were essential in the diagnosis. In one of the cases a large splenic laceration was diagnosed by these two techniques 23 days following trauma. Ultrasound is of particular value and can be performed with ease in the clinical follow-up of patients who have sustained multiple injuries requiring immobilisation and orthopaedic traction.

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Cited by (7)

Ultrasonography in traumatic splenic rupture
1992, Clinical Radiology
Ultrasound (US) findings and their significance for the clinical outcome were studied in a series of 56 patients hospitalized with a diagnosis of splenic trauma. US was abnormal in 50 cases (89.3%) on admission, revealing intraperitoneal fluid in 41 (73.2%) and a splenic parenchymal injury and/or subcapsular haematoma in 35 (62.5%). US was abnormal in 24/25 patients undergoing urgent surgery, 23/26 undergoing successful non-surgical treatment and 2/5 patients undergoing delayed surgery within 1 to 3 days of a repeat US (abnormal in all five). The presence of intraperitoneal haemorrhage preoperatively was shown accurately by US in 29 cases (96.7%), and the splenic origin of the haemorrhage in 19 (63.3%). Repeat US was of most value for confirming the diagnosis by demonstrating splenic lesions not visible initially. The need for laparotomy could not be predicted on the basis of the US findings alone, however.
Delayed rupture of the spleen
1990, Annals of Emergency Medicine
The concept of delayed splenic rupture is an evolving one. The cases reviewed have led us to reserve the term “delayed splenic rupture” for the situation in which early post-traumatic imaging of the spleen is normal and is followed by the diagnosis of splenic hemorrhage 48 or more hours after the initial insult.
Post-traumatic splenic evaluation is indicated when the mechanism of injury is likely to injure the spleen, there is unexplained hypovolemia, or the patient complains of left upper quadrant pain or tenderness. Peritoneal lavage is indicated when hypovolemia is the main manifestation. Radionuclide study is used for screening isolated splenic or hepatic injury when the suspicion is low. Reduced availability of visceral angiogram has resulted in CT scan becoming the main diagnostic modality.
When a patient presents with blunt abdominal trauma, awareness of the problem of splenic rupture and active diagnostic approach may help reduce the morbidity and mortality associated with splenic hemorrhage, either immediate or delayed.
Delayed presentation of blunt splenic injury
1988, The American Journal of Surgery
Eleven patients with delayed presentation of splenic injury after blunt abdominal trauma treated during a 10 year period have been described. They represented 24 percent of all patients treated for blunt splenic injury in our department in that time period. Ten patients required operative treatment and one was treated nonoperatively. There were no deaths. The value of computerized tomography and ultrasonography in the accurate preoperative assessment of splenic injury has been documented. In addition, the various diagnostic and therapeutic possibilities in blunt splenic trauma have been discussed.
Delayed splenic rupture: Case reports and review of the literature
2005, Journal of Trauma - Injury, Infection and Critical Care
Occult splenic injury: Delayed presentation manifesting as jaundice
2001, Emergency Medicine Journal
Traumatic pseudocyst of the spleen
1999, Journal of the Royal Society of Medicine

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Delayed splenic rupture: A true entity

Journal of Pediatric Surgery

Clinical Radiology

American Journal of Surgery

Radiologic Clinics of North America

Seminars in Nuclear Medicine

American Journal of Surgery

Echographic evaluation of splenic injury after blunt trauma

Radiology

Occult rupture of the spleen

Annals of Surgery

Delayed rupture or delayed diagnosis of rupture of the spleen

Surgery, Gynecology and Obstetrics

Liver spleen imaging for trauma-revisited

Clinical Nuclear Medicine

Ruptured spleen. Some refinement in its roentgenologic diagnosis

Radiology

Further refinements in the plain radiologic diagnosis of splenic rupture: air enema

Radiology

The conservative management of splenic trauma

Journal of Pediatric Surgery

The syndrome of occult rupture of the spleen

Archives of Surgery

Evaluation of abdominal trauma by computed tomography

Radiology

Hemoperitoneum studied by computed tomography

Radiology

Radionuclide scan findings in delayed splenic rupture

Radiology

Radionuclide imaging and ultrasound in liver/spleen trauma: a prospective comparison

Radiology

Splenic trauma: assessment of problems in diagnosis

American Journal of Roentgenology