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Non-Operative Management of Delayed Splenic Rupture 4 Months Following Blunt Abdominal Trauma

Challenging differential diagnosis, Management of emergency care

Athanasios G. Kofinas, Kalliopi E. Stavrati, Nikolaos G. Symeonidis, Efstathios T. Pavlidis, Kyriakos K. Psarras, Inna N. Shulga ORCID logo, Alexandra G. Marneri, Christina C. Nikolaidou, Theodoros E. Pavlidis

Greece Second Surgical Propedeutic Department, Aristotle University of Thessaloniki, School of Medicine, Hippocration Hospital, Thessaloniki, Greece

Am J Case Rep 2021; 22:e932577

DOI: 10.12659/AJCR.932577

Available online: 2021-07-12

Published: 2021-08-21


#932577

BACKGROUND: Delayed splenic rupture is a rare complication of non-operative management of a primary splenic trauma which, without proper clinical vigilance, may result in life-threatening events. It usually occurs 4-8 days after injury and, in most cases, surgery is the treatment of choice. Since non-operative management of splenic trauma, which allows splenic salvage, has become increasingly popular, the same approach could also be applied in delayed splenic rupture. We herein present a case of delayed splenic rupture that occurred 4 months after the trauma and was successfully managed non-operatively.
CASE REPORT: A 32-year-old woman presented with diffuse abdominal pain, chest pain, and dyspnea 4 months after sustaining minor thoracoabdominal blunt trauma due to a car accident. That event was inadequately investigated and was not admitted for further monitoring. Computerized tomography revealed a rupture of a splenic hematoma in the context of the previous splenic trauma. She was closely monitored and remained hemodynamically stable. She was discharged and followed up, with no reported relapse of her clinical condition.
CONCLUSIONS: Delayed splenic rupture occurring 4 months after the primary splenic trauma is extremely rare. Due to its prolonged delay, delayed rupture of the spleen can easily be overlooked and not be included in the original differential diagnosis. Negligence of this event can result in dreaded complications with hemodynamic instability or even death. Furthermore, its higher mortality rate compared to primary splenic rupture highlights the importance of proper clinical vigilance. Non-operative management should be attempted in hemodynamically stable patients.

Keywords: Abdominal Injuries, Spleen, splenic rupture



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