Delayed splenic rupture

Facial trauma evaluation leading to a diagnosis of delayed splenic rupture

A patient presented 48 hours after falling and sustaining facial fractures and was evaluated in an outpatient setting. The patient had been seen at 2 other hospitals, including a level I trauma center, and discharged home. While undergoing evaluation for his facial trauma, the patient became severely hypotensive. The patient was diagnosed with a delayed splenic rupture and underwent splenectomy.

Delayed splenic rupture: dating the sub-capsular hemorrhage as a useful task to evaluate causal relationships with trauma

The aim of the paper was to perform a chronological assessment of the phenomenon of delayed rupture of the spleen, to assess the phenomenological order about the sub-capsular hematoma transformation to determine the causal relationship with trauma as hypothetical cause of death. 80 cases of blunt trauma with splenic capsular hematoma and subsequent rupture of the spleen were evaluated: 38 had an acute rupture of the spleen, 42 presented a break in days or weeks after the traumatic injury. Time between the traumatic event and delayed rupture of the spleen is within a range of time from one day to more than one month. Data recorded included age, sex, type of trauma, injury severity score, grade of splenic injury, associated intra-abdominal injuries, pathologic specimen evaluation. Immunohistochemical investigation of perisplenic hematoma or laceration was performed utilizing polyclonal antibodies anti-fibrinogen, CD61 and CD68, and showed structural chronological differences of sub-capsular hematoma. Expression of modification and organization of erythrocytes, fibrinogen, platelets and macrophages provides an informative picture of the progression of reparative phenomena associated with sub-capsular hematoma and subsequent delayed splenic rupture. Sub-capsular splenic hematoma dating, which we divided into 4 phases, is representing a task in both clinical practice and forensic pathology.

A new spleen-preserving technique using radiofrequency ablation technology

BACKGROUND

Splenic salvage is the ultimate goal of the treatment for splenic injury. We experimentally investigated a spleen salvage technique after spleen injury using radiofrequency ablation technology.

METHODS

A grade IV spleen trauma was produced in 10 white male Landrace pigs (the lower pole of the spleen was sharply divided at the level where the lower hilar vessel enters the organ) under general anesthesia. A Radionics Cooltip Radio Frequency needle was used to stop the bleeding in every case. The electrode was inserted in four to six different sites and each session lasted for 2 to 6 minutes.

RESULTS

All bleeding sites were controlled intraoperatively with no additional means. Postoperatively, all animals appeared clinically healthy, and at the time the animals were killed, no blood, pus, or other fluid was identified in the abdomen or chest. Subcapsular or perisplenic hematomas were not found either.

CONCLUSION

We believe that radiofrequency ablation may be used in splenic injury to stop bleeding, especially when blood transfusion or surgery is indicated. This procedure may reduce the frequency of open surgery for repair of the injury, the number of splenectomies, and the amount of blood transfusion required. The advantage of use under ultrasound or computed tomographic guidance or laparoscopically makes it even more appealing. Thus, we suggest that further study in human subjects is required to validate our results.

Delayed splenic rupture presenting as unstable angina pectoris: case report and review of the literature

The diagnosis of delayed rupture of the spleen can be challenging if the history of trauma is remote, or initially missed. Delayed rupture of the spleen can occur in approximately 1% of blunt force injuries to the spleen. We present a difficult case of delayed rupture of the spleen from remote, minor trauma and discuss the literature associated with this injury.

Delayed splenic hematoma rupture

The diagnosis of splenic hematoma can be clinically challenging. A case of delayed rupture of an atraumatic splenic hematoma is described, illustrating how unusual the presentation of this entity can be.