Delayed rupture of the spleen. A case report

Area of Science:

• Trauma Surgery
• Diagnostic Imaging
• Abdominal Surgery

Background:

• Delayed splenic rupture is a rare but serious complication following blunt abdominal trauma.
• Initial diagnostic imaging, including liver/spleen scintigraphy, may not detect splenic injuries immediately.
• Patients may present with a delayed onset of symptoms, mimicking other acute abdominal conditions.

Observation:

• A patient with significant thoracoabdominal trauma presented with an initially normal liver/spleen scintigram and a benign clinical course.
• Twenty-three days post-trauma, the patient experienced an acute abdominal crisis.
• Emergency ultrasound revealed hemoperitoneum and a subcapsular hematoma, leading to laparotomy.

Findings:

• Splenic rupture was confirmed during laparotomy, despite the absence of immediate post-traumatic diagnosis.
• A splenectomy was not required, indicating successful conservative management or less severe splenic injury.
• Postoperative liver/spleen scintigraphy showed a persistent defect, contrasting with the initial normal scan.

Implications:

• This case underscores the diagnostic challenge of delayed splenic rupture.
• It emphasizes the need for vigilant monitoring and repeat imaging in patients with thoracoabdominal trauma, even after an initial negative workup.
• Timely diagnosis and appropriate management are crucial for favorable outcomes in delayed splenic rupture cases.