Splenic Injury After Blunt Abdominal Trauma
Background: The spleen is the most commonly injured viscus in blunt abdominal trauma. Abdominal pain with left upper quadrant tenderness or signs of peritonitis in a patient with history of trauma is the most common presentation of this condition.
Objective: To describe an unusual presentation of splenic rupture in a patient with history of motor vehicle crash and blunt abdominal trauma.
Case Report: A young man was brought to the Emergency Department with a history of being in a motor vehicle crash 10 h earlier. He experienced gradually worsening difficulty breathing while sitting or lying down for the previous 4 h, although he was asymptomatic in the upright position. He was transported to the hospital standing upright, supported by two men, on the open back of a vehicle normally used to transport cattle. The patient was found to have left upper quadrant abdominal tenderness on examination and free fluid in the pelvis on the focused abdominal sonography for trauma examination done while the patient was standing. A grade III splenic injury with hemoperitoneum was diagnosed on computed tomography scan and the patient was treated with splenectomy.
Conclusion: We report an unusual presentation of a splenic injury in a young man who had symptoms only in the supine position.
The spleen is the most commonly injured viscus in blunt abdominal trauma and can result from the most trivial of traumas. The classical presentation is that of a hemodynamically unstable patient with a history of trauma, with severe abdominal pain and signs of peritonitis. However, the absence of hemodynamic instability, pain, or tenderness does not rule out splenic injury. A thorough physical examination and prompt imaging studies in the form of ultrasound or computed tomography (CT) scan may be needed to rule out intra-abdominal visceral injuries, to prevent delay in treatment as well as to decrease morbidity and mortality from this injury.
Abstract and Introduction
Abstract
Background: The spleen is the most commonly injured viscus in blunt abdominal trauma. Abdominal pain with left upper quadrant tenderness or signs of peritonitis in a patient with history of trauma is the most common presentation of this condition.
Objective: To describe an unusual presentation of splenic rupture in a patient with history of motor vehicle crash and blunt abdominal trauma.
Case Report: A young man was brought to the Emergency Department with a history of being in a motor vehicle crash 10 h earlier. He experienced gradually worsening difficulty breathing while sitting or lying down for the previous 4 h, although he was asymptomatic in the upright position. He was transported to the hospital standing upright, supported by two men, on the open back of a vehicle normally used to transport cattle. The patient was found to have left upper quadrant abdominal tenderness on examination and free fluid in the pelvis on the focused abdominal sonography for trauma examination done while the patient was standing. A grade III splenic injury with hemoperitoneum was diagnosed on computed tomography scan and the patient was treated with splenectomy.
Conclusion: We report an unusual presentation of a splenic injury in a young man who had symptoms only in the supine position.
Introduction
The spleen is the most commonly injured viscus in blunt abdominal trauma and can result from the most trivial of traumas. The classical presentation is that of a hemodynamically unstable patient with a history of trauma, with severe abdominal pain and signs of peritonitis. However, the absence of hemodynamic instability, pain, or tenderness does not rule out splenic injury. A thorough physical examination and prompt imaging studies in the form of ultrasound or computed tomography (CT) scan may be needed to rule out intra-abdominal visceral injuries, to prevent delay in treatment as well as to decrease morbidity and mortality from this injury.
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