[2-stage rupture of the spleen]

Two-stage ruptures of the spleen are a difficult diagnostic problem of closed abdominal trauma. Diagnostic errors occur in 85% of cases. The causes of the errors are the peculiar pathogenesis of this trauma of the spleen, which has a two-stage character, and the circumscribed position of the pathological focus in relation to the free abdominal cavity. In true two-stage ruptures of the spleen, the pathological focus is delimited by the intact capsule of the organ, in false rupture it is delimited by a complex of factors leading to anomalous block of fibrinolysis in the ++peri-splenic clot which plugs the rupture in the organ and causes temporary arrest of the bleeding. The possible causes of the anomaly are discussed. Six personal cases are analysed, and the diagnostic recommendations in the examination of patients with suspected two-stage rupture of the spleen are generalized.