DOI: http://dx.doi.org/10.18203/2349-2902.isj20214380

Delayed splenic rupture and conservative management: case series

Marta A. Silva, Nídia Moreira, José Baião, Carlos E. Costa Almeida

Abstract


Splenic injury is frequent in patients with abdominal trauma and delayed splenic rupture yields a poorer prognosis. Patients with hemodynamic stability, despite the grade of splenic anatomical injury, can be safely treated by conservative management (observation or angiography/angioembolization), if no other intra-abdominal injuries are found and a multidisciplinary team (surgeons, interventional radiologists) is available. The conservative approach is an alternative to surgery and its possible complications. In this case series, the authors present three trauma cases very commonly seen in emergency rooms, in whom delayed splenic rupture was diagnosed. All three patients were submitted to conservative management, with no need for surgery or complications.  This case series presents some common clinical signs and diagnostic steps, also showing the safety and efficacy of clinical observation in this setting.


Keywords


Delayed splenic rupture, Conservative management, Blunt abdominal trauma

Full Text:

PDF

References


Stivelman RL, Glaubitz JP, Crampton RS. Laceration of the spleen due to nonpenetrating trauma. Am J Surg. 1963;106(6):888-91.

Benjamin CI, Engrav LH, Perry JF. Delayed rupture or delayed diagnosis of rupture of the spleen. Surg Gynecol Obstet. 1976;142(2):171-2.

Foster RP. Delayed haemorrhage from the ruptured spleen. BJS. 1970;57(3):182-92.

Olsen WR, Polley TZ. A Second Look at Delayed Splenic Rupture. Arch Surg. 1977;112(4):422-5.

Dang C, Schlater T, Bui H, Oshita T. Delayed rupture of the spleen. Annals of Emergency Medicine. 1990.

Coccolini F, Montori G, Catena F, Kluger Y, Biffl W, Moore EE, et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg. 2017;12(1):1-26.

Evans C. Ductless glands: Rupture of the spleen from external violence. Trans Pathol Soc London. 1866;(17):299-301.

Berlatzky Y, Shiloni E, Anner H, Weiss Y. “Delayed rupture of the spleen” or delayed diagnosis of the splenic injury? Isr J Med Sci. 1980;16(9–10):659-64.

Zabinski, Edward J, Harkins HN. Delayed splenic rupture: a clinical syndrome following trauma. Arch Surg. 1943;46(2):186.

Gamblin TC, Wall CE, Royer GM, Dalton ML, Ashley DW. Delayed splenic rupture: Case reports and review of the literature. J Trauma - Inj Infect Crit Care. 2005;59(5):1231-4.

Freiwald S. Late-Presenting Complications After Splenic Trauma. Perm J. 2010;14(2):41-4.

Resteghini N, Nielsen J, Hoimes ML, Karam AR. Delayed splenic rupture presenting 70 days following blunt abdominal trauma. Clin Imaging. 2014;38(1):73-4.

Olsen WR. Delayed rupture of the spleen as an index of diagnostic accuracy. Surg Gynecol Obstet. 1974;138(1):82.

Sizer JS, Wayne ER, Frederick PL. Delayed Rupture of the Spleen. Arch Surg. 1966;92(3):362.

Müller JX. Die traumatische Spätblutung der Milz. Beitr z kiln Chir. 1940;376-411.

Pachter HL, Guth AA, Hofstetter SR, Spencer FC. Changing patterns in the management of splenic trauma: The impact of nonoperative management. Ann Surg. 1998;227(5):708-19.

Di Cataldo A, Puleo S, Li Destri G, Racalbuto A, Trombatore G, Latteri F, et al. Splenic trauma and overwhelming postsplenectomy infection. British Journal of Surgery. 1987.

Lynch AM, Kapila R. Overwhelming postsplenectomy infection. Infect Dis Clin North Am. 1996;10(4):693-707.

Cullingford GL, Watkins DN, Watts ADJ, Mallon DF. Severe late postsplenectomy infection. Vol. 78, British Journal of Surgery. 1991;716-21.

Smith J, Armen S, Cook CH, Martin LC. Blunt Splenic Injuries: Have We Watched Long Enough? J Trauma Inj Infect Crit Care. 2008;64(3):656-65.

Schurr MJ, Fabian TC, Gavant M, Croce MA, Kudsk KA, Minard G, et al. Management of Blunt Splenic Trauma. J Trauma Inj Infect Crit Care. 1995;507-13.

Williamson J. Splenic injury: diagnosis and management. Br J Hosp Med [Internet]. 2015;76(4):204-29.

Poletti P-A, Wintermark M, Schnyder P, Becker CD. Traumatic injuries: role of imaging in the management of the polytrauma victim (conservative expectation). Eur Radiol. 2000;12(5):969-78.

Chiu WC, Cushing BM, Rodriguez A, Ho SM, Mirvis SE, Shanmuganathan K, et al. Abdominal Injuries without Hemoperitoneum. J Trauma Inj Infect Crit Care. 1997;42(4):617-25.

Piccolo CL, Trinci M, Pinto A, Brunese L, Miele V. Role of contrast-enhanced ultrasound (CEUS) in the diagnosis and management of traumatic splenic injuries. J Ultrasound. 2018;21(4):315-27.

Furlan A, Tublin ME, Rees MA, Nicholas DH, Sperry JL, Alarcon LH. Delayed splenic vascular injury after nonoperative management of blunt splenic trauma. J Surg Res. 2017;211:87-94.

McCray VW, Davis JW, Lemaster D, Parks SN. Observation for nonoperative management of the spleen: How long is long enough? J Trauma - Inj Infect Crit Care. 2008;65(6):1354-8.