Delayed splenic rupture: a suggestion for "predictive monitoring"

Two cases of delayed splenic rupture are presented. In one, splenic damage was demonstrated on Day 29 following trauma, and rupture of the organ occurred 2 days later. In the second patient, splenic trauma was documented 1 day after an accident, and rupture occurred on Day 26. Each case was marked by the fact that only one spleen scan had been performed (in the first case because of discovery only long after the trauma, and in the second case because of the patient's failure to return). That is, while damage to the spleen was evident, there was no follow-up to document healing. Based on this, it is suggested that spleen imaging be carried out soon after trauma. If a trauma-related defect is shown, then a repeat study may be mandatory to document healing. Lack of such healing, or failure to progress at a normal rate, may be an altering sign to impending splenic rupture. Hence, "predictive monitoring" by early and then repeat imaging at a later date, is proposed.