Delayed presentation of splenic injury: still a common syndrome

The entity of delayed splenic rupture represents an initially missed injury, a delayed presentation of the latter, or an actually delayed development of an initially latent, minor, splenic injury. Having encountered a number of patients presenting with splenic rupture days after what was considered a minor abdominal trauma we review our experience with this entity. This is a retrospective study. During the past 6 years 26 patients were treated at our level II trauma center for blunt splenic injuries. The 8 patients who presented 48 h or more after injury are the focus of this communication. All patients had an underlying medical condition: five were drug addicts (one was HIV positive) and the other three were affected by cirrhosis, sickle cell disease, and HIV. The mechanisms of injury were as follows: blunt assault in 5 patients, a fall in 2 patients, and unknown in 1 patient. The patients presented to our hospital after a mean lag time of 5 days after injury (range, 2-10 days). One patient presented in shock and underwent laparotomy after a positive diagnostic peritoneal lavage. Four presented with a clinical acute abdomen, and three presented with abdominal pain and anemia. Abdominal computed tomography (CT) was performed in the seven hemodynamically stable patients demonstrating hemoperitoneum in all: five had a grade III injury and two had a grade II injury. All patients survived after an emergency splenectomy. Delayed presentation of splenic injury after minor abdominal trauma is not uncommon in our indigenous population. It may be associated with drug abuse and HIV.