Case report: traumatic avulsion of the left kidney and spleen with diaphragmatic rupture in a young worker

Blunt abdominal trauma is a major cause of morbidity and mortality across all age groups. Among solid organs, the spleen and liver are most frequently injured, followed by the kidneys. Diaphragmatic injuries are rare and typically result from high-impact trauma, often occurring alongside other intra-abdominal injuries.

We present the case of a 21-year-old male who sustained multiple injuries following a fall from a height of ten meters. Upon arrival, he was pale, tachycardic, and irritable, with an oxygen saturation of 80% and a blood pressure of 100/50 mmHg. Resuscitation was initiated immediately. Focused Assessment with Sonography for Trauma revealed intra-abdominal free fluid. After initial stabilization, a whole-body computed tomography scan demonstrated a grade IV-V splenic injury, hemothorax, and an ectopic left kidney located above the spleen. Emergency laparotomy revealed complete avulsion of the left kidney, splenic rupture, a diaphragmatic tear, and a serosal injury at the splenic flexure. Surgical intervention included splenectomy, left nephrectomy, and primary repair of the diaphragm.

Diaphragmatic injuries are reported in only 1% of blunt trauma cases, most often on the left side. They are frequently missed due to non-specific symptoms and associated organ injuries. Early recognition and surgical repair are essential to prevent complications. Hemodynamically unstable patients with high-grade solid-organ injuries require immediate operative management.

Simultaneous avulsion of the spleen and kidney with diaphragmatic rupture is extremely rare. Prompt diagnosis and surgical intervention are vital for favorable outcomes in such complex trauma cases.