Splenic rupture manifesting two years after diagnosis of injury

Delayed formation of splenic pseudoaneurysm following nonoperative management in blunt splenic injury: multi-institutional study in Osaka, Japan

BACKGROUND

Delayed rupture is well-known as a severe complication after splenic injury treated with nonoperative management (NOM). The incidence and timing of splenic pseudoaneurysm (SPA) formation, which is a cause of delayed rupture following splenic injury, have not been thoroughly investigated, and the timing of follow-up computed tomography (CT) is controversial. The objective of this study was to clarify the incidence and timing of both the delayed formation and spontaneous resolution of SPA following splenic injuries treated with NOM in several trauma centers in Japan.

METHODS

This was a retrospective review of all patients with documented blunt splenic injury who were treated with NOM from 2003 through 2010 in five trauma and critical care centers.

RESULTS

The present study consisted of 104 patients, including 16 patients (15.4%) with delayed formation of SPA (7 patients with Grade II and 9 with Grade III) during their clinical course. SPA was diagnosed with enhanced CT at a mean (SD) of 4.6 (2.1) hospital days (range, 1-8 days) after admission. Delayed formation of SPA was found in 30.4% of Grade II injuries and in 18.4% of Grade III injuries. Eight patients with delayed formation of SPA were observed without transcatheter arterial embolization during their entire stay. These SPAs were spontaneously occluded on follow-up enhanced CT or angiography. Spontaneous occlusion of SPA was confirmed at 5.2 (2.6) hospital days (range, 2-10 days) after diagnosis of delayed SPA.

CONCLUSION

Delayed formation of SPAs was recognized with enhanced helical CT in 15% of all patients during hospital Days 1 to 8. About one half of the SPAs had occluded spontaneously without therapeutic intervention. Our results suggested that follow-up enhanced CT performed approximately 1 week after splenic injury may be useful to detect delayed SPA formation.

LEVEL OF EVIDENCE

Epidemiologic study, level III.

Spontaneous occlusion of splenic and renal pseudoaneurysm after blunt abdominal trauma: a case report and literature review

Pseudoaneurysms caused by blunt abdominal trauma are rarely observed in solid organs. The preferred therapy for pseudoaneurysm after blunt abdominal trauma is often angiography and embolization. Here, we report a case of a spontaneous occlusion of splenic pseudoaneurysm and renal pseudoaneurysm after blunt abdominal trauma. Angiography and embolization were not required, and contrast-enhanced multi-detector computed tomography was used to monitor the patient. This case shows that spontaneous occlusion can be one of the possible outcomes of intraparenchymal splenic pseudoaneurysm and renal pseudoaneurysm after blunt abdominal trauma.

Delayed rupture of spleen in a case of spouse abuse

This case deals with assault of a housewife by her husband. Although there had been previous episodes of abuse, the gravity of the present injury, which required hospitalization, resulted in the fact being made known to others. Insistence on a wife's right to protection and shelter from a husband who assaults her has grown significantly in the wake of the women's liberation movement. However, it remains the case that few women in Sri Lanka would take action and risk disrupting their families.

Observation of splenic trauma: when is a little too much?

A 12-year-old boy was treated conservatively for a grade II splenic laceration. On discharge, he was instructed to avoid contact sports, running, and strenuous physical activity. Thirty-eight days later, after diving off the side of a swimming pool, he had abdominal pain, nausea, and diaphoresis. On admission, he was hemodynamically unstable. Results of a diagnostic lavage showed gross blood. At laparotomy, a fractured spleen was found, and splenectomy was performed. He recovered without complication. This case questions the activity restrictions placed on patients with conservatively managed splenic trauma. Avoidance of only contact sports and heavy exertion may be inadequate.