Abstract:The condition can be classified simply into atraumatic-idiopathic (7.0 per cent) and atraumatic-pathological (93.0 per cent) splenic rupture. Splenomegaly, advanced age and neoplastic disorders are associated with increased ASR-related mortality.
“…The diagnosis in this case is heavily based on imaging and as discussed, the use of incorrect phase of contrast may have played a role in clouding the presence of an initial insult. Severe coagulopathy or inflammation resulting in splenic rupture has been documented [20] and is possible in the context of the trauma patient but his coagulation profile (INR 1.1) along with ROTEM (Rotational thromboelastometry) and platelet function studies were unremarkable on presentation.…”
Background: Blunt injury of the spleen is common and with the shift towards nonoperative management in haemodynamically stable patients, the delayed development of splenic artery pseudoaneurysms are of great concern. Management traditionally involves angioembolisation with the intent to preserve splenic function; however recent studies suggest that this is not without complication. Case presentation: We present a rare case of delayed splenic pseudoaneurysm arising 6 days post motorbike accident, with initial computerised tomography showing no evidence of splenic injury. The patient was successfully embolised and progressed well without complication. No clear cause was found for his development of splenic injury. Conclusions: Splenic artery pseudoaneurysms are not uncommon and necessitate follow-up imaging after nonoperative management of blunt splenic trauma. Once diagnosed, embolisation versus conservative management can be considered on a case-by-case basis.
“…The diagnosis in this case is heavily based on imaging and as discussed, the use of incorrect phase of contrast may have played a role in clouding the presence of an initial insult. Severe coagulopathy or inflammation resulting in splenic rupture has been documented [20] and is possible in the context of the trauma patient but his coagulation profile (INR 1.1) along with ROTEM (Rotational thromboelastometry) and platelet function studies were unremarkable on presentation.…”
Background: Blunt injury of the spleen is common and with the shift towards nonoperative management in haemodynamically stable patients, the delayed development of splenic artery pseudoaneurysms are of great concern. Management traditionally involves angioembolisation with the intent to preserve splenic function; however recent studies suggest that this is not without complication. Case presentation: We present a rare case of delayed splenic pseudoaneurysm arising 6 days post motorbike accident, with initial computerised tomography showing no evidence of splenic injury. The patient was successfully embolised and progressed well without complication. No clear cause was found for his development of splenic injury. Conclusions: Splenic artery pseudoaneurysms are not uncommon and necessitate follow-up imaging after nonoperative management of blunt splenic trauma. Once diagnosed, embolisation versus conservative management can be considered on a case-by-case basis.
“…Atraumatic splenic rupture is an uncommon, well‐described,1 and often misdiagnosed2 presentation with severe consequences if unrecognized. An absence of a history of trauma does not rule out splenic rupture and defines the atraumatic entity.…”
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confidence: 99%
“…An absence of a history of trauma does not rule out splenic rupture and defines the atraumatic entity. Treatment generally consists of total splenectomy in prevision of functional compromise 1. Subsequent histologic examination will help determine whether the rupture is atraumatic‐pathologic or atraumatic‐idiopathic 1.…”
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confidence: 99%
“…Treatment generally consists of total splenectomy in prevision of functional compromise 1. Subsequent histologic examination will help determine whether the rupture is atraumatic‐pathologic or atraumatic‐idiopathic 1. The latter is rarer, comprising 7% of atraumatic splenic rupture cases, and remains a diagnosis of exclusion 1.…”
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confidence: 99%
“…Subsequent histologic examination will help determine whether the rupture is atraumatic‐pathologic or atraumatic‐idiopathic 1. The latter is rarer, comprising 7% of atraumatic splenic rupture cases, and remains a diagnosis of exclusion 1. The lack of a predisposing factor3 and a normal histologic examination discriminate the atraumatic‐idiopathic entity from the atraumatic‐pathologic one.…”
Key Clinical MessageAtraumatic splenic rupture is a rare, but well‐documented and life‐threatening clinical entity that is often misdiagnosed. Clinicians should include this entity in their differential diagnosis using clinical judgement even in the absence of a history of trauma.
A 23-year-old otherwise healthy man presented to the emergency department after a 3-hour flight with complaints of headache and severe abdominal pain. His symptoms followed a 1-day discharge from a recent hospital admission for a viral illness. He denied any history of trauma, and the remaining medical history was unremarkable. At the time of evaluation, he reported associated left shoulder pain and was in noticeable distress. Physical examination revealed a distended abdomen with associated diffused peritoneal signs. He was afebrile, with a heart rate of 77 beats/min, blood pressure of 96/46 mm Hg, oxygen saturation of 100% in room air, and a respiratory rate of 16 breaths/ min. Abdominal ultrasonography was performed (Figure 1). A B Figure 1. Ultrasonography image of the right (A) and left (B) upper quadrants of the abdomen.
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