Delayed Splenic Rupture due to an Occult Primary Injury

Area of Science:

• Trauma Surgery
• Abdominal Imaging
• Emergency Medicine

Background:

• The spleen is highly susceptible to blunt abdominal trauma due to its anatomical location.
• Hemodynamically unstable patients with splenic trauma typically undergo splenectomy.
• Delayed splenic rupture is an uncommon but serious complication, often following seemingly minor injuries.

Observation:

• This case details a delayed splenic rupture occurring eight weeks post-minor abdominal trauma.
• The patient presented with classic signs including left hypochondrium tenderness, positive Kehr's sign, and tachycardia.
• Initial imaging may be normal, underscoring the challenge in early diagnosis.

Findings:

• Computed tomography (CT) confirmed delayed splenic rupture and hemoperitoneum.
• Subcapsular hematoma, hemodynamic instability, and abdominal pain are common sequelae.
• Kehr's sign is frequently observed in patients with splenic injury.

Implications:

• Close monitoring and routine follow-up of trauma patients are essential for detecting delayed complications.
• Prompt diagnosis via CT imaging is critical for appropriate management of delayed splenic rupture.
• Understanding this rare entity improves patient outcomes and surgical decision-making.