Abstract: Objective:To summarize the experiences in the diagnosis and treatment of delayed rupture of spleen.
Methods:The clinical data of 26 patients with traumatic delayed rupture of spleen who were admitted to the Dachang Hospital from January 2005 to December 2013 were analyzed retrospectively. The medical history, clinical presentation, results of laboratory examinations were analyzed, and the splenic trauma was graded. Surgical procedures were selected according to the condition, severity of the splenic trauma and time of injury. Patients were followed up via outpatient examination or telephone interview till June 2014.
Results:Twenty six patients had the history of injury of the left hypochodriac region, and were accompanied by slight abdominal pain and a short period of pain alleviation, and then pain in all regions of the abdomen at postoperative hour 48. All the patients had pale face, tenderness, rebound tenderness or tonus. The pulse above 100 per minute was observed in 20 patients, and 15 patients had blood pressure under 90/60 mmHg (1 mmHg=0.133 kPa). The level of hemoglobin under 5 g/L was observed in 3 patients, and 5 -10 g/L in 21 patients. All the 26 patients received abdominal paracantesis, non coagulating blood was extracted in 25 patients. Twenty six patients received B ultrasonography, and 24 had splenic rupture. Nineteen patients received computed tomography (CT), and 19 had splenic rupture. Ten patients had type Ⅰ splenic rupture, 12 had type Ⅱ splenic rupture, 3 had type Ⅲ splenic rupture and 1 had type Ⅳ splenic rupture. All the 26 patients received operation, including 2 received suture of the ruptured spleen, 2 received resection of the lower part of the spleen, 9 received total splenic resection, and 13 received total splenic resection+autogeneous transplantation of greater omentum. Two patients died of hemorrhagic shock 〖HJ*6〗intraoperatively, and the other 24 patients were cured. The operation time and volume of hemoperitoneum were (90±15)minutes and (1 500±700)mL, respectively.Twenty four patients received blood transfusion, with the volume of transfused blood of 1 200 mL. The mean duration of hospital stay was 16.7 days. Two patients had complications after the operation, which were left pleural effusion and splenic fossa effusion, and they were cured by symptomatic treatment. No infection or other complications were observed. All the 24 patients were followed up for 6 -108 months (median, 46 months). One patient died of myocardial infarction at postoperative year 5, and the other 23 patients survived.
Conclusion:B sonography and computed tomography are important methods for the treatment of delayed rupture of spleen. Traumatic delayed rupture of spleen should be considered when the patient had symptoms including history of injury of the left hypochondriac region, the course of abdominal pain, abdominal pain alleviation, abdominal pain recurrence, time for abdominal pain alleviation longer than 48 hours, interperitoneal hemorrhage and the signs of splenic rupture indicated by B ultrasonography and computed tomography. The indication of spleen preservation surgery or splenectomy for patients with delayed rupture of spleen should be strictly controlled and optimal surgical procedure should be designed according to the condition of the patient.