Delayed Splenic Rupture; Normal Appearing Spleen on the Initial Multidetector Computed Tomography (MDCT) Can...

Area of Science:

• Trauma Surgery
• Diagnostic Imaging
• Emergency Medicine

Background:

• Delayed splenic rupture (DSR) is a rare but serious complication following blunt abdominal trauma.
• Typically, initial CT scans reveal splenic injury in DSR cases.
• DSR is associated with higher mortality than acute splenic injuries.

Observation:

• This case presents an extremely rare instance of DSR after blunt trauma.
• The initial post-trauma MDCT scan showed a normal spleen.
• The patient developed DSR despite the initial normal imaging findings.

Findings:

• DSR requires a high index of suspicion for diagnosis.
• Serial imaging studies are crucial for early DSR detection.
• Normal initial CT does not exclude DSR in hemodynamically unstable patients.

Implications:

• Consider DSR in late post-trauma hemodynamic instability, even with a normal initial CT.
• Recommend repeat MDCT scans 2-3 days post-trauma for high-impact injuries or peri-splenic trauma.
• Emphasize the importance of timely diagnosis and management of DSR to reduce mortality.