A CASE OF DELAYED SPLENIC RUPTURE ONE MONTH AFTER ABDOMINAL INJURY

Abstract

A 57-year-old man was hit by an automobile, and was transferred to our hospital. A chest X-ray revealed left hemothorax associated with multiple rib fracture. An abdominal CT disclosed a small laceration on the upper portion of the spleen. Non-operative management was done since his general condition was stable. Three days after admission, we confirmed a hemostat of the spleen by a CT. He was discharged on the 16^th day after admission. Twenty days after the discharge he was re-admitted with an acute abdominal pain. A CT scan revealed a rupture in the lower half of the spleen and enormous hemorrhage in his abdominal cavity. An emergency laparotomy and splenectomy were performed.
Recently splenic rupture due to blunt trauma is managed non-operatively if the condition permits. We should consider the possibility of delayed splenic rupture. The exact mechanism of delayed splenic rupture is not yet known, though intrasplenic hematoma might have perforated into the peritoneal cavity in our case. Since delayed splenic rupture is reported to occur within 2 weeks of the initial injury in most cases, patients should be observed very closely for 2 weeks after injury, and a scheduled examination might be recommended.