[Splenic rupture not always painful: diagnostics after blunt abdominal trauma]

In blunt abdominal traumata the spleen is the most frequently and often the only injured organ. Splenic rupture can result in severe abdominal pain and haemodynamic instability, but may only have mild symptoms. A normal physical exam following abdominal trauma does not exclude splenic rupture.

A general practitioner referred a 34-year-old patient with a clean medical history to our hospital for an abdominal ultrasound for progressive abdominal pain and blood cells in the urine after blunt abdominal trauma sustained in a bicycle accident two days previously. Because of intra-abdominal free fluid seen on ultrasound we performed a CT scan which showed a grade 3 splenic rupture. The patient was treated conservatively and discharged after two days of clinical observation.

Intra-abdominal injuries after blunt abdominal trauma can present late and with only mild symptoms. New or progressive symptoms indicate the need for further imaging investigations. Non-operative treatment is indicated for most haemodynamically stable patients with splenic rupture; exercise restrictions and outpatient check-ups are necessary.