Delayed rupture of the spleen: Case report

We present a case of delayed rupture of the spleen with perisplenic hematoma in a fifty-five year old male which coincides with the observation expressed by Zabmski and Harkins²⁴ that “delayed splenic rupture is most common in males in the third decade of life.”This patient had recuperated from the shock of his late acute internal hemorrhage suffered thirteen days prior to surgery, and was operated upon eight months plus days after his unrecalled injury through a mistaken diagnosis of carcinoma of the stomach. The history and symptoms were all confusing and this case illustrates the difficulties in diagnosis and shows how insidious and treacherous this syndrome may be. He would unquestionably have gone on for a variable period before another possibly fatal hemorrhage occurred. Such a case helps explain the very prolonged cases reported in the literature.The postoperative course was complicated by pneumonia from which this patient recovered.His chief complaints during his early observation were those of hypertension with dizziness headaches, and fullness of the head, and anorexia, weight loss, weakness, cough, and precordial pain; later were added nocturia, epigastric and left hypochondriac pain, and nausea.The unusual symptoms in this case at variance with the accepted literature on the subJect of delayed rupture of the spleen are a hypertension (of 220/120) and a nocturia (of four to five times). This is difficult to explain except on the basis of the mass exerting pressure on the left kidney or/and left renal artery. Following surgery his nocturia ceased and his blood pressure dropped to 140/76.The incidence of delayed rupture of the spleen in our five-year series of thirteen cases including this case, is two cases of delayed hemorrhage and eleven cases of acute hemorrhage (2 in 13). Of this group four cases including the present one, were isolated and uncomplicated cases of splenic rupture.