Delayed Spleen Bleeding
Literature Review
DOI:
https://doi.org/10.55175/cdk.v53i02.1711Keywords:
Spleen, delayed spleen hemorrhage, DSH, ruptured spleenAbstract
Delayed spleen hemorrhage (DSH) is defined as rupture or hemorrhage of the spleen occurring 48 hours or more after blunt trauma. Although relatively uncommon, DSH is associated with a higher mortality rate compared to acute splenic injury. The interval between the initial trauma
and the onset of DSH may range from several days to weeks or even months, and it may also occur following minor trauma. The spleen is a highly vascular organ, making splenic injury a potentially life-threatening condition due to the risk of intra-abdominal hemorrhage. DSH can develop in patients who were previously hemodynamically stable and had no radiological evidence of splenic injury on initial imaging. Diagnosis is often challenging because clinical manifestations may be nonspecific and long time interval since the trauma. Imaging studies, particularly computed tomography, play a crucial role in confirming the diagnosis and assessing the severity of splenic injury. Management of DSH depends on the patient’s hemodynamic status and the grade of the splenic injury, and may include non-operative management, embolization, or surgical intervention. Early recognition is essential to improving clinical awareness, accelerating diagnosis, and reducing morbidity and mortality risks.
Downloads
References
Basukala S, Tamang A, Bhusal U, Sharma S, Karki B. Delayed splenic rupture following trivial trauma: a case report and review of literature. Int J Surg Case Rep. Elsevier; 2021;88:106481. doi: 10.1016/J.IJSCR.2021.106481.
Jahromi AH, Migliaro M, Romano M, Sangster G. Delayed splenic rupture; normal appearing spleen on the initial multidetector computed tomography (MDCT) can sometimes be misleading. Trauma Mon. 2016;21(5): e24465. doi: 10.5812/traumamon.24465.
Maria C, Nickolaos T, George G, Michail K. Delayed splenic rupture 4 months following minor blunt abdominal trauma. Global Journal of Rare Diseases 2021;6(1):001–3. doi: 10.17352/2640-7876.000029.
Freiwald S. Late-presenting complications after splenic trauma. Perm J. 2010;14(2):41–4. doi: 10.7812/TPP/09-101
Waseem M, Bjerke S. Splenic injury. Operative techniques in general surgery. StatPearls Publishing; 2024;2(3):192–205. Treasure Island (FL): StatPearls Publishing; 2024. PMID: 28723022.
Shoultz TH, Minei JP. Spleen. In: Feliciano D V, Mattox KL, Moore EE, editors. Trauma, 9e. [Internet]. New York, NY: McGraw Hill; 2020. Available from: accesssurgery.mhmedical.com/content.aspx?aid=1175138310.
Akoury T, Whetstone DR. Splenic rupture. StatPearls [Internet]. 2023 [cited on 2024 Oct 10]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525951/.
Hassan R, Abd Aziz A, Md Ralib AR, Saat A. Computed tomography of blunt spleen injury: a pictorial review. Malays J Med Sci. 2011;18(1):60–7. PMID: 22135575.
Harmon L, Bilow R, Shanmuganathan K, Lauerman M, Todd SR, Cardenas J, et al. Delayed splenic hemorrhage: myth or mystery? a Western Trauma Association multicenter study. Am J Surg. 2019;218(3):579–83. doi: 10.1016/j.amjsurg.2019.06.025.
Borio G, Semeraro G, Manzo E, Maffi PAM, Etteri M. Delayed splenic rupture after a minor blunt trauma: a case report and literature review. Emer Care J. 2022;18(3). doi: 10.4081/ecj.2022.10822.
Shinkai T, Ono K, Masumoto K, Urita Y, Gotoh C. A rare mechanism of delayed splenic rupture following the nonoperative management of blunt splenic injury in a child. Surg Case Rep. 2018;4(1):75. doi: 10.1186/s40792-018-0477-5.
Furlan A, Tublin ME, Rees MA, Nicholas DH, Sperry JL, Alarcon LH. Delayed splenic vascular injury after nonoperative management of blunt splenic trauma. J Surg Res. 2017;211:87–94. doi: 10.1016/j.jss.2016.11.062.
Davies DA, Fecteau A, Himidan S, Mikrogianakis A, Wales PW. What’s the incidence of delayed splenic bleeding in children after blunt trauma? an institutional experience and review of the literature. J Trauma Injury, and Crit Care. 2009;67(3):573–7. doi: 10.1097/TA.0B013E318190392B.
Notrica DM, Sayrs LW, Bhatia A, Letton RW, Alder A, St. Peter S, et al. The incidence of delayed splenic bleeding in pediatric blunt trauma. J Pediatr Surg. 2018;53(2):339–43. doi: 10.1016/j.jpedsurg.2017.10.005.
Su YC, Ou CY, Yang TH, Hung KS, Wu CH, Wang CJ, et al. Abdominal pain is a main manifestation of delayed bleeding after splenic injury in patients receiving non-operative management. Sci Rep. 2022;12(1):19871. doi: 10.1038/s41598-022-24399-9.
Kozar RA, Crandall M, Shanmuganathan K, Zarzaur BL, Coburn M, Cribari C, et al. Organ injury scaling 2018 update: spleen, liver, and kidney. J Trauma and Acute Care Surg. 2018;85(6):1119–22. doi: 10.1097/TA.0000000000002058.
Rastogi V, Singh D, Tekiner H, Ye F, Mazza JJ, Yale SH. Abdominal physical signs of inspection and medical eponyms. Clin Med Res. 2019;17(3–4):115–26. doi: 10.3121/CMR.2019.1420.
Chung JS, Choi JW, Jung PY. Unexpected delayed rupture of the spleen that initially appeared normal on computed tomography. Trauma Image and Procedure. 2019;4(1):19–21. doi: 10.24184/tip.2019.4.1.19.
Sedik A, AlRashed F, AlDawoodi T, ElSayed M, Elhoushy S. Delayed splenic rupture: a case report and literature review. J Curr Surg. 2017;7(3):42–4. doi: 10.14740/jcs323w.
Mandell J. Core radiology: a visual approach to diagnostic imaging. 1st ed. Cambridge: Cambridge University Press; 2013.
Anyanwu CT, Reynal SD. Delayed splenic rupture resulting in massive intraperitoneal hemorrhage post ambulatory-related injury. Cureus. 2018;10(2):e2160. doi: 10.7759/cureus.2160.
CDC. ACIP Altered Immunocompetence Guidelines for Immunizations [Internet]. 2024 [cited on 2024 Oct 3]. Available from: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Juven Luvianto, I Wayan Periadijaya
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
