Carlin Margo, Elkbuli Adel, Maka Piueti, McKenney Mark, Boneva Dessy
Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA.
Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA; Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA.
Int J Surg Case Rep. 2022 Sep;98:107517. doi: 10.1016/j.ijscr.2022.107517. Epub 2022 Aug 13.
Delayed splenic rupture is an often unpredictable event with high mortality. In this report, we discuss the successful management of delayed splenic rupture, presenting days after index injury, with no commonly associated injuries or blunt abdominal trauma.
A 50 year old male, not on anticoagulants, presented with blunt trauma after driving his motorcycle into a tree. The patient sustained right 3-5 rib fractures, displaced right midclavicular fracture, 25 % right pneumothorax, T5-9 posterior spinous process fractures, left 2nd-5th metatarsal fractures, and scattered abrasions to the left foot, knee and hand. Focused abdominal sonography for trauma (FAST) and admission abdominal multi-detector CT were negative for any intra-abdominal injuries. On hospital day 5, the patient acutely decompensated. FAST was grossly positive and emergent laparotomy revealed a splenic rupture. After a splenectomy, he recovered.
The spleen is the most commonly injured organ in blunt abdominal trauma. Although acute injury often presents with imaging findings or sequelae of hemorrhagic shock, complications of splenic trauma have the potential to result in delayed catastrophe. Bedside ultrasonography is a useful tool to assess acute decompensation in trauma patients along with CT imaging. Prompt identification and hemorrhage control are crucial to survival after trauma.
Repeat CT scans are also important for the identification of delayed splenic rupture and timely intervention. Delayed hemorrhage after blunt trauma should never be ruled out regardless of the injury complexity or length of hospital admission.
延迟性脾破裂是一种常常难以预测的事件，死亡率很高。在本报告中，我们讨论了延迟性脾破裂的成功处理方法，该病例在初次受伤数天后出现，无常见的相关损伤或钝性腹部创伤。
一名50岁男性，未服用抗凝剂，骑摩托车撞到树上后遭受钝性创伤。患者右侧第3 - 5肋骨骨折、右侧锁骨中段移位骨折、25%的右侧气胸、T5 - 9棘突后骨折、左侧第2 - 5跖骨骨折，左脚、膝盖和手部有散在擦伤。创伤重点超声检查（FAST）及入院时腹部多排CT检查均未发现任何腹腔内损伤。住院第5天，患者病情突然恶化。FAST检查结果明显为阳性，急诊剖腹探查发现脾破裂。脾切除术后，患者康复。
脾脏是钝性腹部创伤中最常受伤的器官。虽然急性损伤常表现为影像学检查结果或失血性休克的后遗症，但脾创伤的并发症有可能导致延迟性灾难。床边超声检查是评估创伤患者急性失代偿情况的有用工具，CT成像也是如此。及时识别和控制出血对于创伤后的生存至关重要。
重复CT扫描对于识别延迟性脾破裂和及时干预也很重要。无论损伤的复杂性或住院时间长短，钝性创伤后的延迟性出血都绝不能排除。
