Abstract
A 79-year-old man fell down while walking and landed on his upper left abdomen. The next day, he was diagnosed with a left 12th rib fracture. Sudden abdominal pain and nausea occurred 6 days after the injury for which he was taken to the emergency room. Computed tomography showed contrast extravasation from the spleen and a massive hemoperitoneum. A hemothorax in the left side of the chest was also observed. In a state of hypovolemic shock, he poorly responded to rapid fluid infusion and blood transfusion, then underwent a splenectomy in the diagnosis of delayed splenic rupture. Perioperative searching revealed an omental traumatic diaphragmatic hernia. Neither a chest wall injury nor lung damage was seen, and the diaphragmatic defect was sutured.
Delayed splenic injury accounts for 0.3-1.7% of blunt splenic injuries, while traumatic diaphragmatic hernia comprises 0.8-1.6% of blunt trauma cases, making it a relatively rare disease. Here we described a case of delayed splenic rupture with traumatic diaphragmatic hernia. Prompt surgery resulted in a good outcome.
