Delayed Rupture of the Spleen—myths, Facts, and Their Importance

Kluger, Yoram; Paul, Douglas B.; Raves, John J.; Fonda, Michele; Young, Joseph C.; Townsend, Ricard N.; Diamond, Daniel L.

doi:10.1097/00005373-199404000-00019

Cited by 77 publications

(48 citation statements)

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“…Delayed rupture is seen in less than 10% of cases. The time period is based on the "latent period of Baudet" of 48 h which Baudet described as time from injury to rupture [3,5,6]. The first case of DSR documented by CT was reported in 1981 by Toombs et al [7].…”

Section: Discussionmentioning

confidence: 99%

Delayed Splenic Rupture: A Case Report and Literature Review

et al. 2017

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The spleen is one of the most commonly injured organs in the body after blunt abdominal trauma. Our objective was to present a case of the rare entity called "delayed splenic rupture", which is the delayed manifestation of splenic injury following a trauma in which the initial ultrasonography study was normal. We also review the previous 13 cases up to 2015 and offer our recommendations. We present a case of a 60-year-old male with a history of road traffic accident 3.5 days prior to admission to our hospital with initial normal ultrasonography scan done at a peripheral referring hospital. He was evaluated and proved to have a large subcapsular splenic hematoma and significant hemoperitoneum. He was offered splenectomy.

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Section: Discussionmentioning

confidence: 99%

Delayed Splenic Rupture: A Case Report and Literature Review

et al. 2017

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“…The so-called delayed splenic rupture represents injury in evolution including both missed primary rupture and true secondary rupture due to either clot lysis beside the injured arterial wall or increasing hematoma by osmotic phenomenon [92,93]. A distinction should be made between true delayed rupture (normal initial CT scan) and delayed recognition of rupture (no initial or misread initial CT scan) [92].…”

Section: Delayed Rupturementioning

confidence: 99%

“…A distinction should be made between true delayed rupture (normal initial CT scan) and delayed recognition of rupture (no initial or misread initial CT scan) [92]. The true clinical entity of delayed rupture is defined as bleeding occurring more than 48 h after blunt trauma in a previously hemodynamically stable patient following an initially normal CT scan [93]. The early utilization of CT scan, before subcapsular hematoma has growth enough to be visible, may also be the reason for the delay in the detection of some discrete splenic injuries [94].…”

Section: Delayed Rupturementioning

confidence: 99%

Traumatic injuries: imaging and intervention in post-traumatic complications (delayed intervention)

Goffette

Laterre

2002

Eur Radiol

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The nonoperative management (NOM) of abdominal trauma has gained increasing acceptance over the past decade. This approach has been extended to severe trauma patients previously considered as candidates for surgery. Consequently, the incidence of delayed and uncommonly encountered complications has increased. Causes of delayed complications are multiple and include: (a) abnormal or insufficient injury healing process; (b) retention of necrotic tissue; (c) secondary infection of initially sterile collections; and (d) underestimation of injury severity. The purpose of this review article is to explain the role of various imaging modalities in detecting post-traumatic delayed complications and to highlight the usefulness of minimally invasive techniques, including laparoscopy, biliary endoscopy, therapeutic angiography and image-guided drainage. Subsequent complications, which do not necessarily negatively influence the final outcome, are often predictable, virtually obligatory consequences of the successful NOM of high-grade or complex abdominal injuries. Between 50 and 60% of those patients with grade-IV or grade-V liver or splenic lacerations require some type of interventional treatment; therefore, indiscriminate discharge of patients with solid organ injury managed conservatively may be potentially harmful. As the incidence of complications is higher for more severe grade-IV or grade-V liver, spleen, or kidney injuries, scheduled follow-up CT scans may be rational in this subset of patients to identify potential complications amenable to early application of interventional techniques. Follow-up CT scans are unnecessary in stable adults or children with low-grade injury. Delayed splenic or hepatic rupture is one of the major concerns because this type of complication remains difficult to predict and historically often requires emergent surgery. These ruptures may benefit from NOM, should the same criteria as for primary rupture be respected. Conversely, parenchymatous focal pooling of contrast on initial CT is a good predictor for the development of delayed vascular malformation. In children, as a large part of splenic and hepatic vascular malformations resolve spontaneously, expectant observation may be indicated provided that a strict imaging follow-up is performed until complete disappearance of these lesions. If needed, embolization of parenchymal vascular lesions should be performed as selectively as possible in order to avoid functional parenchyma loss and to reduce the risk of secondary infection of hematoma or ischemic tissue. Technical improvements, such as microcatheter systems and direct percutaneous approach to targeted lesions, have widened the potential for safe endovascular management of acquired vascular malformations. Advantages and disadvantages relative to the different embolic agents are explained. Endoscopic retrograde pancreatography is the chief investigational tool for detecting biliary and pancreatic ducts injuries. The respective roles of endoscopic, percutaneous and surgical approaches...

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“…It may, however, present days after the original trauma [1] and may occur spontaneously [2] or after only minor trauma [3,4]. Spontaneous rupture or rupture after minimal trauma is more likely when the spleen is already abnormal [5,6,7].…”

Section: Introductionmentioning

confidence: 99%

Occult splenic rupture with cardiovascular collapse: a report of three cases in critically ill patients

Kandasamy

Thomas

Reeve

2002

Intensive Care Medicine

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Three cases of splenic rupture causing cardiovascular collapse in critically ill patients are discussed. The first patient had received cardiopulmonary resuscitation (CPR) in the days before the collapse, the second patient was recovering from severe sepsis and the third patient was recovering from severe sepsis, had received CPR and had undergone percutaneous endoscopic gastrostomy (PEG). The diagnosis was made at post mortem in two of the patients, the third patient, who bled following PEG, survived after prompt surgical intervention. Splenic rupture should be considered as part of the differential diagnosis of unexpected cardiovascular collapse in patients who have received CPR or who are recovering from sepsis.

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Delayed Rupture of the Spleen—myths, Facts, and Their Importance

Cited by 77 publications

References 0 publications

Delayed Splenic Rupture: A Case Report and Literature Review

Delayed Splenic Rupture: A Case Report and Literature Review

Traumatic injuries: imaging and intervention in post-traumatic complications (delayed intervention)

Occult splenic rupture with cardiovascular collapse: a report of three cases in critically ill patients

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