spleenspleenDelayed rupture?Delayed rupture?

REDA SALEM HUSSEIN.FRCSROYAL SHREWSBURY HOSPITAL

Anatomy Anatomy

1 Inch thick1 Inch thick 3 Inches wide3 Inches wide 5 Inches long5 Inches long 7 “70 to 150Grams weight7 “70 to 150Grams weight 11 to 9 the ribs11 to 9 the ribs

Liagments&SurfacesLiagments&Surfaces

Gastro-splenicGastro-splenic Leino-phrenicLeino-phrenic Leino-colicLeino-colic

Costo-phrenicCosto-phrenic

Visceral :stomach,pancreas,colonVisceral :stomach,pancreas,colon

Mr.A.M 64 BuilderMr.A.M 64 Builder GP referal to medics at 3.15 pm 20/02GP referal to medics at 3.15 pm 20/02 Pain lt. flankPain lt. flank Radiating to lt.shoulderRadiating to lt.shoulder Gradual onset for 5/7Gradual onset for 5/7 No definitive trauma?!No definitive trauma?!

Case 1

Examination/investigationsExamination/investigations

Pulse 100/min regPulse 100/min reg BP 165/90BP 165/90 Temp 37.4Temp 37.4 St 97%St 97%

? Mass luq? Mass luq USS: spleen not recognised.USS: spleen not recognised. 17.5 cm mass,irregular,cystic areas17.5 cm mass,irregular,cystic areas may be splenic originmay be splenic origin

Examination/investigationsExamination/investigations

22/02 pain eased off22/02 pain eased off

CT scan CT scan

Large collection in spleen,Large collection in spleen,

May be abscessMay be abscess

Haematoma can not be excludedHaematoma can not be excluded

Referred for surgeryReferred for surgery

23/02 Laparotomy23/02 Laparotomy

Large subcapsular haematomaLarge subcapsular haematoma Some blood around the spleenSome blood around the spleen Spleenectomy performedSpleenectomy performed Antibiotic coverAntibiotic cover

Intra splenic haematomaIntra splenic haematoma

Published dataPublished data

Isr.Med.Science 1980Isr.Med.Science 1980 293 blunt trauma293 blunt trauma 278 within 24 hours(mort. 1%)278 within 24 hours(mort. 1%) 15 surgery after 48 hours or more15 surgery after 48 hours or more 3 were true delayed haemmoraghe3 were true delayed haemmoraghe 12 were diagnostic error12 were diagnostic error

Historical debate!Historical debate!

1907 Baudet latent period1907 Baudet latent period 1932 McIndoe 26 case,97% within3 1932 McIndoe 26 case,97% within3

weeks of traumaweeks of trauma 1966 Sizer et al 14% delayed rupture,first 1966 Sizer et al 14% delayed rupture,first

to describe intrasplenic &subcapsularto describe intrasplenic &subcapsular 1970’s use of peritoneal lavage,incdence 1970’s use of peritoneal lavage,incdence

dropped 1-2%dropped 1-2% 1980’s CT monitoring showed injury in 1980’s CT monitoring showed injury in

evolution!evolution!