Khan Suhail Aslam, Muhammad Izz, Laabei Fadal, Rothwell Jane
Department of Surgery, Naas General Hospital, Naas co, Kildare, Ireland.
Cases J. 2009 Jun 16;2:6450. doi: 10.4076/1757-1626-2-6450.
The diagnosis of Delayed Splenic Rupture poses a major challenge to even the most astute clinician, as it can mimic other medical emergencies. We present a case of an unusual presentation of delayed splenic rupture in a 23-year-old Caucasian man, who presented to the emergency department with a 2 day history of left upper quadrant pain. He initially denied any history of trauma. There were no signs of generalized peritonisim on examination but his haemoglobin level was low (8.9 gm/dl) for which there was no obvious cause identified. He was resuscitated and a computed tomography of the abdomen was performed. This revealed complete rupture of the splenic capsule with haemorrhagic fluid in the abdomen. With the computed tomography abdomen findings and further questioning of the patient, the only potential precipitating event that he could remember was a minor kick to the left upper quadrant more than 2 weeks ago while playing football. An urgent splenectomy was performed and histology confirmed complete rupture of the splenic capsule with a large adherent haematoma to the capsule. This case illustrates the difficulty in diagnosing delayed splenic rupture especially when accurate history is not available. A high index of suspicion is essential as delay in diagnosis can be fatal. Early diagnosis in suspected cases can be achieved by performing computed tomography of the abdomen.
延迟性脾破裂的诊断对即使是最敏锐的临床医生来说也是一项重大挑战，因为它可能会模仿其他医疗急症。我们报告一例23岁白人男性延迟性脾破裂的不寻常病例，该患者因左上腹疼痛2天就诊于急诊科。他最初否认有任何外伤史。检查时没有发现弥漫性腹膜炎的体征，但他的血红蛋白水平较低（8.9克/分升），且未发现明显原因。对他进行了复苏，并进行了腹部计算机断层扫描。结果显示脾包膜完全破裂，腹腔内有出血性液体。根据腹部计算机断层扫描结果以及对患者的进一步询问，他唯一能记得的可能诱发事件是2周多前踢足球时左上腹受到轻微撞击。遂紧急进行了脾切除术，组织学检查证实脾包膜完全破裂，包膜上有一个大的粘连性血肿。该病例说明了诊断延迟性脾破裂的困难，尤其是在无法获得准确病史的情况下。高度怀疑至关重要，因为诊断延迟可能是致命的。对于疑似病例，通过进行腹部计算机断层扫描可以实现早期诊断。
