DELAYED RUPTURE OF THE SPLEEN - MYTHS, FACTS, AND THEIR IMPORTANCE - CASE-REPORTS AND LITERATURE-REVIEW

Over a 1-year period, three patients were seen in our trauma service w ith delayed bleeding (greater than or equal to 7 days) from an initial ly inapparent splenic injury. This entity was defined as a late occurr ence of signs and symptoms attributed to splenic injury not detected b y diagnostic computed tomographic (CT) scanning during the initial exa mination. We believe that this represents an ''injury in evolution'' m inor enough to go undetected on initial CT scans of the abdomen. A hig h index of suspicion and liberal utilization of imaging techniques are essential for the identification of delayed splenic rupture. Further multicenter studies are required to delineate the true incidence of it s occurrence and its clinical significance. We conclude that ''delayed rupture'' of the spleen is a true clinical entity. The occurrence of a delayed rupture may prove hazardous to patients discharged early fro m the hospital after blunt abdominal injury. A classification system t o assess this type of injury is suggested.