Further refinements in the plain radiologic diagnosis of splenic rupture: the air enema

Plain film radiography, by appraisal of the soft tissues of the descending colon and left paracolonic gutter, comprises a safe, accurate, and quick determination of the presence of free fluid, which, in the proper clinical setting, indicates splenic rupture. The air enema, introduced under fluoroscopic control, is a valuable aid in eliminating false negatives and false positives, and also in distinguishing intraperitoneal clots from subserosal hematoma. The preoperative diagnosis was correct in 27 of 28 cases. The one error occurred in a case in which the interpretation of paravesical fluid (dog ears) was faulty, and in which the air enema had not been used.