Delayed Splenic Rupture Resulting in Massive Intraperitoneal Hemorrhage Post Ambulatory-Related Injury

Delayed splenic rupture, once thought to be unusual, but now growing in incidence, is an issue that could potentiate severe morbidity and mortality to patients, regardless of the severity of the trauma. This case report presents one instance of delayed splenic rupture following minor trauma and discusses the need for further investigation in the management of this condition. A middle-aged, hypotensive male presented to the emergency department (ED) with signs of an acute abdomen following a syncopal episode, with successful resuscitation upon arrival. Computed tomography (CT) revealed fluid in the gastrohepatic ligament, as well as the right pericolic gutter, along with findings suggestive of a perforated peptic ulcer. General surgery was consulted, and an exploratory laparotomy was performed. However, during exploration, no such perforation was found. A large amount of blood was visualized in the left upper quadrant. The spleen was mobilized, and inspection revealed a posterior rupture, resulting in a splenectomy and subsequent hemostasis by the surgical team. The post-operative period was uneventful, with the patient revealing a previous fall onto a concrete floor two weeks prior to presentation to the ED. A pathological examination of the spleen revealed capsular tear with focal congestion and hemorrhage. It is the goal of this report to highlight the morbidity and mortality that occur after delayed splenic rupture, even with minor traumatic events. Current guidelines suggest nonoperative management of splenic injury in stable patients with low-grade splenic injuries after blunt abdominal trauma. However, with the varied presentation and difficulty in the assessment of delayed splenic rupture, patients may be exposed to undue risks with current recommendations on the management of splenic injuries. Further research is needed to find the best practice in managing, and possibly preventing, delayed splenic rupture in patients presenting with an acute abdomen or abdominal trauma.