Delayed splenic rupture following trivial trauma: A case report and review of literature

Abstract

Introduction and importance Delayed Splenic Rupture (DSR) is a rare but well-known presentation of Blunt Splenic Injury (BSI), most of which occur due to motor accidents, fall from height or direct blow to the left thorax or abdomen. Here we present a case of DSR five days after a trivial trauma. Case presentation A 37-year-old female presented with pain in the left-hypochondrium after an accidental bump against a furniture at home. Initially, it was a grade III splenic injury but upon arrival to our hospital from her hometown it had progressed to grade IV. Since the patient was hemodynamically stable, non-operative management (NOM) was chosen with close monitoring at the intensive care unit (ICU). However, the next morning, the patient deteriorated, showing signs of hemorrhagic shock, and a successful emergency splenectomy was done. Clinical discussion Over the last two decades, there has been an increasing inclination of surgeons towards NOM, even for high grade injury. NOM failure has been found to be associated with advancing age, high Injury Severity Score (ISS) or splenic injury. Some factors that improve the success of NOM are admission to ICU/floor, frequent monitoring of hemoglobin/hematocrit, vital signs, abdominal examination, and limiting heavy physical activity. Conclusion Clinicians should not limit the possibility of occurrence of DSR to only major traumatic events. It is imperative that a detailed history of major or trivial trauma in the preceding weeks be elicited for any patients presenting with abdominal pain.

Successful conservative management of a large traumatic mesenteric hematoma: A case report

“…He mentioned that the pain was transient and did not remember the incident as significant. This shows the importance of eliciting a detailed history of major or minor trauma for any patients with abdominal pain, as highlighted in other cases too [10] .…”

Delayed massive bleeding from minor splenic injury due to mechanical chest compression for cardiopulmonary resuscitation

“…Patients diagnosed postmortem or immediately after CPR showed large lacerations or other concomitant fatal injuries. In contrast, delayed bleeding from a splenic injury rarely occurs after minor blunt trauma 6 . Common causes of delayed bleeding from splenic injury are pseudoaneurysms, pseudocysts, or disruption of the subcapsular hematoma 7 .…”

“…In contrast, delayed bleeding from a splenic injury rarely occurs after minor blunt trauma. 6 Common causes of delayed bleeding from splenic injury are pseudoaneurysms, pseudocysts, or disruption of the subcapsular hematoma. 7 To the best of our knowledge, delayed bleeding from splenic injury after CPR has rarely been reported.…”

Delayed splenic rupture presenting 8 days following blunt abdominal trauma due to a motor vehicle accident

“…DSR can present post-soft tissue trauma to the abdomen, initial scans are not usually negative [ 12 ]. As seen with a 37-year-old female patient who presented with a grade III splenic injury that progressed to a ruptured spleen [ 12 ].…”