Delayed splenic rupture: understanding the threat

The spleen is the most commonly injured organ in blunt abdominal trauma and is also frequently injured as a result of penetrating trauma to the left torso or upper abdomen. Most splenic injuries manifest at the moment of injury with symptoms of acute intraperitoneal hemorrhage and shock. Delayed rupture of the spleen after trauma is an unusual outcome but one that exists. In delayed splenic rupture (DSR) there may be an asymptomatic period between initial injury and the appearance of signs of internal hemorrhage. Close evaluation of the degree of splenic injury by utilizing the Splenic Injury Scale as proposed by the American Association for the Surgery of Trauma (AAST), the presence of subcapsular hematoma, pseudocyst, or pseudo aneurysm all must be entertained. It is imperative that the practitioner caring for this population have a working knowledge of the risk factors, diagnostic studies and interventions needed to promptly intervene thus reducing the morbidity and mortality associated with the splenic trauma and subsequent delayed rupture.