Delayed diagnosis of splenic injury

Case contribution: Dr Radhiana Hassan


  • A 26 years old man
  • Involved in MVA and admitted for head injury
  • Sustained left parietal boneĀ  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
Contrast-enhanced CT abdomen in axial plane soft tissue window

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


  • 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
Axial CT brain in bone window shows the left temporal and parietal bone fracture (yellow arrows) with air pockets in scalp
Axial CT brain in soft tissue window shows the subarachnoid hemorrhage (blue arrows)
Author: radhianahassan