Traumatic rupture of the spleen

“…Scant reference has been made to Schorr and Danon's (1967) technique in the recent literature. State, Getzen, and Laning (1969), in an analysis of IOO cases of splenic rupture, mentioned that they found ' no particular diagnostic examination to be of specific unequivocal benefit ' in these cases, while Sargison, Cole, and Kyle (1968)~ in their series of 45 cases, used radiographs merely to confirm the presence of fractured ribs or other intrathoracic injuries.…”

Section: Discussionmentioning

confidence: 99%

Ruptured spleen: A radiological pitfall and a suggested modification

Leigh

1973

Journal of British Surgery

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The diagnosis of splenic injury may be obvious from the outset, or it may either be masked by other injuries or present much later in the phase of convalescence. Delayed rupture may occur as late as 1 month after injury, at which time it may be embarrassing for the doctor and dangerous for the patient. Any additional diagnostic measure is therefore considered appropriate in cases of abdominal trauma. Schorr and Danon (1967) described the value of a film taken in the left lateral decubitus position with barium in the stomach, and noted the significance of a distance of more than 3 cm. from the greater curvature of stomach to the lateral abdominal wall. A case is described in the present paper in which a false‐positive result was obtained with the method of Schorr and Danon (1967) owing to interposition of a heavy mobile omentum. A right lateral decubitus film had been taken while the patient had a gas‐filled stomach, and had revealed a distance of only 2.2 cm. between the greater curve and lateral abdominal wall. In this projection the mobile omentum had obviously fallen away, allowing the stomach to rise towards the left abdominal wall and thus demonstrating the absence of a fixed mass in this region. Although it would appear that this technique is more useful in cases of delayed rupture than in acute cases, it is suggested that routine use be made of the right lateral decubitus film with a gas‐filled stomach, prior to films being taken according to Schorr and Danon's (1967) method. This modification might also be useful in the diagnosis of diseases of the spleen, and in following the progress of patients after treatment.

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“…Abdominal symptoms may occur in up to 48% and abdominal pain in up to 12% of patients with infectious mononucleosis 1 . However, any history of pain radiating to either shoulder is atypical and suggests the possible formation of a splenic haematoma 3 . Prior to the development of peritonism and hypovolemia, a lesion can sometimes be demonstrated by abdominal ultrasound examination 4 …”

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confidence: 99%