Delayed Splenic Rupture; Normal Appearing Spleen on the Initial Multidetector Computed Tomography (MDCT) Can Sometimes Be Misleading

Abstract

Introduction: Delayed splenic rupture (DSR) is an unusual outcome following blunt abdominal trauma. Although DSR is defined as bleeding more than 48 hours after blunt trauma in a previously hemodynamically stable patient, a review of the reported cases in the literature shows that in almost all of the cases the initial CT imaging revealed some form of damage to the spleen. Case Presentation: Here we describe an extremely rare condition in a case that presented with a DSR following blunt trauma and had a normal appearing spleen in the initial post trauma MDCT scan. Conclusions: DSR is a serious consequence of trauma and is associated with a significantly higher mortality rate compared with the overall mortality for acute splenic injuries. A High index of suspicion along with the liberal serial utilization of the imaging studies are the essential elements for early detection of DSR. We propose that DSR be considered as a differential diagnosis in patients presenting with hemodynamic instability late post trauma, even when the immediate post trauma MDCT scan has shown a normal appearing spleen. We suggest that every patient with a high impact injury or injuries to peri-splenic organs should have a repeat MDCT scan 2 -3 days post trauma or before the patients is discharged from hospital.

A rare case of delayed splenic rupture following initial negative CT scan imaging: A case report and review of the literature

“…There are currently no evidence-based algorithms recommending delayed imaging studies based on index radiography, which may contribute to the 3–15 % incidence of DSR [8] . Studies have found that repeat CT scans at 48 h of blunt splenic injury may be able to identify delayed splenic vascular trauma, splenic pseudoaneurysms (SPA), and/or arterial extravasation [17] , [19] , [20] . Furthermore, repeated CT scans have been recommended in patients with an AAST grade 2 splenic injury or higher, left lower posterior rib fractures, intraperitoneal fluid adjacent to the spleen, and/or injury of the left upper quadrant [17] , [21] .…”

Delayed splenic rupture presenting 8 days following blunt abdominal trauma due to a motor vehicle accident

“…While DSR had been reported in the literature in patients post motor vehicle accidents (MVA). Two patients reported in the literature presented with multiple injuries including multiple rib fractures rather than soft tissue trauma, which was initially seen in our patient [ 10 , 11 ]. Moreover, both patients presented within 5 days and within the same hospital admission.…”

The predictive value of CTSI scoring system in non-operative management of patients with splenic blunt trauma: The experience of a level 1 trauma center

“…Many reports have discussed the causes of DSVI after NOM. Thus, Jahromi et al attributed splenic rebleeding after an initial NOM to a subcapsular hematoma that was not detected by CECT early after injury but subsequently expanded and ruptured [31] . Furthermore, Uyeda et al Escalated the importance of dual-phase CT protocol in detecting arterial SVI in the initial CECT [32] .…”