Delayed splenic rupture

To evaluate the features and outcomes of delayed splenic rupture in the hope of developing a strategy to avoid future delayed diagnoses, all splenic injury patients treated over a 5-year period (1988-1992) in Chang Gung Memorial Hospital were reviewed, and 10 patients were found to meet the criteria for delayed splenic rupture. The average period of delay was 11.2 days. Eight had histories of trivial trauma, while the other two had histories of alcohol abuse and seizures. The diagnosis was made by abdominal ultra-sound in five, abdominal computed tomography in three, by diagnostic peritoneal lavage in one and on clinical grounds alone in the other. The average period of preoperative evaluation was 9.3 hours (4-17 hours). All underwent surgery and all required splenectomy. The average intraperitoneal blood volume at the time of laparotomy was 1870 ml. The average intraoperative blood loss was 110 ml. Differential diagnosis of left upper quadrant abdominal pain is limited. A history of trivial or questionable trauma, such as inebriation or seizure within the previous month, should always be elicited, followed by abdominal sonography or computed tomography whenever in doubt. The early diagnosis of delayed splenic rupture, allows for early surgery to reduce the amount of blood transfusion required.