Dang C, Schlater T, Bui H, Oshita T
Department of Emergency Medicine, King/Drew Medical Center, Los Angeles, California 90059.
Ann Emerg Med. 1990 Apr;19(4):399-403. doi: 10.1016/s0196-0644(05)82346-7.
The concept of delayed splenic rupture is an evolving one. The cases reviewed have led us to reserve the term "delayed splenic rupture" for the situation in which early post-traumatic imaging of the spleen is normal and is followed by the diagnosis of splenic hemorrhage 48 or more hours after the initial insult. Post-traumatic splenic evaluation is indicated when the mechanism of injury is likely to injure the spleen, there is unexplained hypovolemia, or the patient complains of left upper quadrant pain or tenderness. Peritoneal lavage is indicated when hypovolemia is the main manifestation. Radionuclide study is used for screening isolated splenic or hepatic injury when the suspicion is low. Reduced availability of visceral angiogram has resulted in CT scan becoming the main diagnostic modality. When a patient presents with blunt abdominal trauma, awareness of the problem of splenic rupture and active diagnostic approach may help reduce the morbidity and mortality associated with splenic hemorrhage, either immediate or delayed.
延迟性脾破裂的概念仍在不断演变。回顾的病例让我们将“延迟性脾破裂”这一术语保留用于以下情况：脾脏创伤后的早期影像学检查正常，而在初次损伤48小时或更长时间后诊断为脾出血。当损伤机制可能损伤脾脏、存在无法解释的血容量不足，或者患者主诉左上腹疼痛或压痛时，需进行创伤后脾脏评估。当血容量不足为主要表现时，需进行腹腔灌洗。当怀疑程度较低时，放射性核素检查用于筛查孤立性脾或肝损伤。内脏血管造影可用性的降低导致CT扫描成为主要的诊断方式。当患者出现腹部钝性创伤时，对脾破裂问题的认识及积极的诊断方法可能有助于降低与脾出血相关的发病率和死亡率，无论是即时还是延迟性的。
