Delayed Traumatic Splenic Injury

• Published in: The American journal of emergency medicine 2017-02, Vol.35 (2), p.375.e3-375.e4
• Main Authors: Nanavati, Pooja, MD, Parker, Brian, MD, MS, Winters, Michael E., MD
• Format: Article
• Language: English
• Subjects: Abdomen; Cysts; Delayed Diagnosis; Emergency; Emergency medical care; Emergency medical services; Hematoma - complications; Hematoma - diagnostic imaging; Hematoma - pathology; Humans; Laparotomy; Male; Middle Aged; Mortality; Spleen; Spleen - diagnostic imaging; Spleen - injuries; Spleen - pathology; Spleen - surgery; Splenectomy; Splenic Diseases - diagnosis; Splenic Diseases - diagnostic imaging; Splenic Diseases - etiology; Splenic Diseases - surgery; Time Factors; Tomography, X-Ray Computed; Trauma centers; Treatment Outcome; Wounds, Nonpenetrating - complications; Wounds, Nonpenetrating - diagnostic imaging; Wounds, Nonpenetrating - pathology
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2016.08.003

Abstract Delayed splenic injury has been well described and typically makes itself known within 2 weeks after a traumatic event. The mortality rate for patients with delayed splenic injury can be as high as 18%. In this report, we describe the course of a 52-year-old man who was brought to our emergency department more than 6 weeks after an acute traumatic injury and was found to have a high-grade splenic injury requiring emergent laparotomy and splenectomy. Emergency care providers should be aware that clinical evidence of splenic injury could be delayed beyond the 2-week period commonly cited in the current literature. Since delayed splenic injury was first reported in 1943 Zabinski and Harkins (1943) [1] , numerous case reports/series have been published about it. Almost all patients with delayed splenic injury in the current literature presented within 2 weeks after acute trauma. Descriptions of the emergence of symptoms beyond 2 weeks are rare Resteghini et al. (2014) [2] . Regardless of the timing, the mortality rate runs as high as 18% Costa et al. (2010) [3] . Emergency care practitioners should consider delayed splenic injury in patients who present beyond the 2-week post-injury period. We describe a man who was injured in a snowboarding incident 6 weeks before his emergency department (ED) presentation. A 52-year-old man with history of hypertension was transported to the ED following a near-syncopal event. During a meeting, he had become lightheaded, diaphoretic, and pale, so his co-workers called 9–1-1. Upon arrival, he was still diaphoretic and pale but not distressed. Vital signs were as follows: blood pressure, 103/74 mm Hg; heart rate, 102 beats/min; respiratory rate, 16 breaths/min; and pulse oximetry reading, 100%, breathing room air. He was afebrile and his glucose level was normal. He described lightheadedness and lower left-sided chest pain. Six weeks earlier, he had fallen while snowboarding and suspected left-sided rib fractures but never sought medical evaluation. The pain had diminished during the weeks preceding his current presentation. The remainder of his systems review was unremarkable. Physical examination was normal, except tenderness in his left lower lateral chest. His abdomen revealed no ecchymosis, distension, rebound, or guarding. The patient was a smoker and had a family history of premature coronary artery disease in first-degree relatives. Given his age, risk factors, and presentation, the initial evaluation focused