Delayed splenic rupture 10 days following blunt abdominal trauma in a child

Delayed splenic rupture is a rare but potentially fatal complication of traumatic splenic injury. Here, we report a fatal pediatric case of delayed splenic rupture 10 days following blunt abdominal trauma. Conservative management resulted in the resolution of symptoms and intra-abdominal hemorrhage. On day 8 of hospitalization, the patient was allowed to sit up in bed. Despite the favorable clinical progress, the patient died within an hour of being left unattended. Autopsy revealed a nearly healed splenic laceration with strict adhesion to adjacent organs; nonetheless, a rupture with a mixed hematoma was observed. This case underscores the importance of considering the risk of re-rupture and vigilant follow-up in patients with splenic injury, even when clinical outcomes are favorable. Delayed splenic rupture is a well-described but rare entity and a potentially fatal complication of traumatic splenic injury. Currently, nonoperative management is the standard approach for pediatric splenic injuries, supported by data showing that >95% of isolated splenic injuries are successfully managed without surgery. Therefore, challenges in clinical prediction and the validity of nonoperative management may inherently become medico-legal issues. Recognizing delayed splenic rupture is indispensable for both clinicians and forensic pathologists to precisely evaluate the medico-legal relevance of distinguishing splenic re-rupture from medical maltreatment or negligence.