Infected splenic hematoma post blunt abdominal trauma

Case contribution: Dr Radhiana Hassan

Clinical:

  • A 43 years old man
  • History of fall from motorbike about one week ago. Described as low impact injury but he fall with handle of motorbike hit left side of abdomen.
  • Having abdominal pain since then which gradually increased in severity.
  • BP=128/72 mmHg, PR=88 bpm, GCS=15/15.
  • Clinically tender at left hypochondriac region.
  • Hb= 11.8 gm/dL and TWBC= 13.4

CT scan findings:

  • The spleen is enlarged. Area of hypodensity within the spleen measuring about 6 cm.
  • Multiple air pockets are seen within the hypodensity (yellow arrow)
  • Minimal perisplenic collection seen.
  • No active contrast extravasation.
  • Other organs are normal.

Intra-operative findings:

  • Large spleen with abscess at midpole.
  • Splenic capsule is intact. Gas bubbles seen in the spleen.
  • Minimal hemoperitoneum.
  • Other organs are normal.

Progress of patient:

  • Initially patient was treated conservatively¬† and planned for percutaneous drainage.
  • However he developed sepsis during admission and open laparotomy done (findings as above).
  • Post operatively noted to have persistent ascitic fluid through drainage tube
  • Blood investigation shows Hepatitis C +ve.
  • Discharged well after 20 days in ward.

Discussion:

 

  • Missed splenic injury is the most common cause of preventable death after blunt abdominal trauma
  • Among previously reported complications of blunt splenic injury are missed splenic injury, delayed rupture, the development of a splenic pseudocyst, liquefaction and infection.
  • Delayed splenic rupture was first described in 1902 with its occurrence 48 hours after trauma. The incidence is approximately 1%, and it tends to occur between 4 and 8 days after injury.¬†Potential mechanisms include expansion of a subcapsular hematoma, clot disruption, or rupture of a pseudoaneurysm or splenic pseudocyst.
  • Prompt recognition of the signs and symptoms of complications of splenic injury is essential for better patient care.
Author: radhianahassan