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Delayed rupture of the spleen
1Department of Emergency Medicine, King/Drew Medical Center, Los Angeles, California 90059.
Annals of Emergency Medicine
|April 1, 1990
Summary
Delayed splenic rupture is defined as splenic hemorrhage diagnosed 48+ hours after normal initial imaging post-trauma. Prompt diagnosis and evaluation of blunt abdominal trauma are crucial for reducing morbidity and mortality from splenic rupture.
Area of Science:
- Trauma Surgery
- Diagnostic Imaging
- Emergency Medicine
Background:
- Delayed splenic rupture is an evolving clinical concept.
- It is defined as splenic hemorrhage occurring 48 hours or more after initial trauma with normal early imaging.
- Post-traumatic splenic evaluation is critical in specific clinical scenarios.
Purpose of the Study:
- To define delayed splenic rupture.
- To outline indications for post-traumatic splenic evaluation.
- To discuss diagnostic modalities for splenic injury.
Main Methods:
- Review of cases to define delayed splenic rupture.
- Discussion of indications for splenic evaluation (mechanism of injury, unexplained hypovolemia, left upper quadrant pain/tenderness).
- Evaluation of diagnostic tools: peritoneal lavage, radionuclide scans, and CT scans.
Main Results:
- Delayed splenic rupture definition established: normal early imaging followed by hemorrhage ≥48 hours post-insult.
- Peritoneal lavage indicated for hypovolemia; radionuclide scans for low-suspicion screening.
- CT scan is the primary diagnostic modality due to reduced visceral angiogram availability.
Conclusions:
- Awareness of delayed splenic rupture is essential in blunt abdominal trauma.
- An active diagnostic approach can decrease morbidity and mortality.
- Timely diagnosis of splenic hemorrhage, whether immediate or delayed, is critical.