Splenic rupture with peri-splenic haematoma and haemoperitoneum

Case contributed by Dr Dayu Gai

Presentation

This young male presented to the Emergency Department with 2-3 hours of gradual onset, severe LUQ pain associated with nausea. He had a CT abdomen and pelvis performed.

Patient Data

Age: 29
Gender: Male

Splenic rupture with a moderate sized peri-splenic haematoma and haemoperitoneum. Can be better visualised on the coronal images.

Case Discussion

This gentleman has a splenic rupture. This can be better visualised on the coronal images. The findings are rather subtle, but also note the small amounts of fluid which are tracking between the mesenteric fat. This fluid appears hyperdense relative to the surrounding fat.

Splenic rupture sits along the spectrum of splenic lacerations. Splenic lacerations are a common occurrence occurring after blunt traumatic injury 1. In the developed world, it is usually associated with motor vehicle accidents. In one study 3, 45% of patients with traumatic abdominal injury demonstrated some sort of splenic laceration. 
Contrast enhanced CT is currently the diagnostic imaging tool of choice.
Features of blunt splenic injury include 2:

  • lacerations: irregular, linear hypodensities
  • non-perfused regions
  • haematoma (subcapsular and parenchymal): hypodense regions which may be compressing the capsule, or within the parenchyma itself respectively
  • active haemorrhage: area of high attenuation on CTA represents active bleeding
  • haemoperitoneum: area of hypodensity due to old blood pooling in the paracolic gutters
  • vascular injury

Patients with low grade splenic lacerations, who are haemodynamically stable and have a non-peritonitic abdomen are usually managed conservatively. Recently, there has been a push to manage haemodynamically unstable patients non-surgically, but with radiological angio-embolisation 3.

Case contributed by A/Prof. Pramit Phal.

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Case Information

rID: 30836
Case created: 6th Sep 2014
Last edited: 3rd Oct 2016
Inclusion in quiz mode: Included

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