Case contribution: Dr Radhiana Hassan
Clinical:
- A 26 years old man
- Involved in MVA and admitted for head injury
- Sustained left parietal bone fracture with subarachnoid hemorrhage
- On Day 2, patient complaint of epigastric pain
- Initially treated as gastritis
- However pain is persistent
- Clinical assessment showed BP=123/60mmHg, PR=130 bpm, GCS=14/15
CT scan findings:
- A ruptured spleen (white arrows) with some parts still shows enhancement
- Associated perisplenic blood collection
- Moderate hemoperitoneum seen
- No other organ injury
Intraoperative findings:
- Shattered spleen, hilum is intact.
- Other internal organ is normal
- Hemoperitoneum about 2600 ml
- Splenectomy done
Diagnosis: Grade V spleen injury
Discussion:
- Injury of the spleen may result in significant morbidity and mortality
- It is often associated with significant blood loss
- Splenic injuries may be missed on the initial presentation especially in polytrauma cases
- Careful clinical examination and ultrasound abdomen may facilitate early diagnosis and reduced any delay in the diagnosis of a ruptured spleen.
Progress of patient:
- Patient was discharged well about 10 days after splenectomy
