Delayed Traumatic Splenic Rupture as a Life-threatening Clinical Manifestation Treatable with Splenectomy: A Study of Twelve Cases and Literature Review.

Abstract

Aim: While most splenic ruptures manifest as immediate hemorrhage, a minority of patients experience delayed rupture, which occurs days to weeks after the initial trauma. Although there have been reports of delayed splenic rupture following trauma, the exact pathophysiology of this condition and the appropriate treatment remain contentious. This article aims to further discuss and summarize the diagnosis and treatment protocols for delayed traumatic rupture of the spleen through the collection and analysis of existing clinical data, combined with previous literature.

Case presentation: From 2012 to 2023, we identified 12 adults admitted to a trauma center with delayed traumatic rupture of the spleen (DRS). After excluding unrelated cases, we focused on patients with a definitive DRS diagnosis. The majority were male, aged 46-90 years, with some having pre-existing conditions like cirrhosis or cancer. Most injuries were from falls or car accidents, occurring 2-7 days before admission. Five patients had additional traumatic injuries. All experienced left-side abdominal pain and were diagnosed using imaging. They received medical intervention to stabilize their condition, with initial hemoglobin levels slightly low.

Results: Clinical data of 12 splenic rupture cases presenting with symptoms between 2 and 7 days after splenic trauma but without any pre-existing splenic pathology were collected from November 2012 to August 2023. Among these cases, 8 patients underwent splenectomy immediately following the diagnosis of delayed splenic rupture. For the remaining 4 patients, conservative treatment was initially attempted, but due to inadequate control of their condition, the treatment plan was subsequently altered to surgical intervention, yielding favorable clinical outcomes.

Conclusions: Delayed splenic rupture is a disease caused by multiple factors. The atypical clinical manifestations of delayed rupture pose challenges to timely and accurate diagnosis, making computed tomography (CT) the preferred diagnostic method for delayed splenic rupture. Emergency surgical treatment is the optimal surgical approach for managing delayed splenic rupture.