Increasing Risk Over Time: Delayed Spleen Rupture After Trauma

Yıl 2014, Cilt: 5 Sayı: 11, 250 - 252, 01.11.2014

Ulvi Mehmet Meral Oğuz Hançerlioğulları Ahmet Turan Ilıca Necati Salman

Öz

Giriş: Künt batın travmasının 48 saat ve sonrasında gelişen
dalak rüptürleri, gecikmiş dalak rüptürü olarak tanımlanır. Tanısal
süreç, yerinde ve zamanında kullanılan focused assessment
with sonography for trauma (FAST) ve bilgisayarlı tomografi (BT)
tetkiklerini içermelidir.
Olgu Sunumu: Çalışmamızda künt batın travması ile başvuran; ilk
başvurusunda muayenesi, ultrasonografi ve BT tetkikleri normal
olarak değerlendirilip önerilerle taburcu edilen 21 yaşındaki erkek
hastaya ait olgu sunulmaktadır. 15 gün sonra artan şikayetlerle
hastaneye başvuran hastada dalak rüptürü tespit edilmiş,
splenektomi sonrası şifa ile taburcu edilmiştir.
Sonuç: Fizik muayene bulguları ve tıbbi öyküsü normal olan künt
batın travmalı hastalarda gecikmiş dalak rüptürü olasılığı göz
ardı edilmemelidir. Tekrarlanan fizik muayene ve FAST önemli
tanısal yöntemler olmakla birlikte yüksek enerjili travma ve
hemodinamik instabilite bulunması durumunda BT gecikmeden
uygulanmalıdır.

Anahtar Kelimeler

Gecikmiş dalak rüptürü, künt abdominal travma, FAST

Increasing Risk Over Time: Delayed Spleen Rupture After Trauma

Öz

Introduction: Delayed rupture of the spleen is defined as splenic rupture occurring 48 hours or more after blunt abdominal trauma. The diagnostic process should involve the timely and proper use of focused assessment with sonography for trauma (FAST) and computerized tomography (CT).Case Report: Our study hereby reports a case of a 21-year-old male patient who sustained a blunt abdominal trauma and who was subsequently discharged due to the observation of normal findings on the initial physical examination, ultrasonography, and CT. The patient was re-admitted to the hospital 15 days later with worsening complaints, after which he was diagnosed with splenic rupture and discharged from the hospital with full recovery after splenectomy.Conclusion: The possibility of delayed splenic rupture should not be overlooked in blunt abdominal trauma patients with normal physical examination findings and a problem-free medical history. Although repeated physical examination and FAST are important diagnostic procedures, CT should be performed without delay in the presence of a high-energy trauma and hemodynamic instability

Anahtar Kelimeler

Delayed splenic rupture, blunt abdominal trauma, FAST

Kaynakça

• Schroeppel TJ, Croce MA. Diagnosis and management of blunt abdominal solid organ injury. Curr Opin Crit Care 2007; 13: 399-404. [CrossRef]
• Resteghini N, Nielsen J, Hoimes ML, Karam AR. Delayed splenic rupture presenting 70 days following blunt abdominal trauma. Clin Imaging 2014; 38: 73-4.[CrossRef]
• Olthof DC, Sierink JC, van Delden OM, Luitse JS, Goslings JC. Time to intervention in patients with splenic injury in a Dutch level 1 trauma centre. Injury 2014; 45: 95-100. [CrossRef]
• Coebergh van den Braak RR, van der Elst M, Scheffers J, Heitmann M. Splenic rupture not always painful: diagnostics after blunt abdominal trauma. Ned Tijdschr Geneeskd 2013; 157: A5295.
• McDonald CC. Delayed splenic hematoma rupture. Am J Emerg Med 1995; 13: 540-2. [CrossRef]
• Parithivel VS, Sajja SB, Basu A, Schein M, Gerst PH. Delayed presentation of splenic injury: still a common syndrome. Int Surg 2002; 87: 120-4.
• O'Connor G, Ramiah V, McInerney J, Moughty A. Splenic rupture visualised with focused assessment with sonography for trauma (FAST): heterogeneous echogenicity of acute haemorrhage following blunt trauma. BMJ Case Rep 2012; 21: 2012.
• Hoskins W, Jacob A, Wijeratne S, Campbell I, Taylor P. Splenic injury admitted to a rural Level 3 trauma centre: a 10-year audit. Aust J Rural Health 2013; 21: 163-9. [CrossRef]