A 40-year-old man sustains blunt abdominal trauma in a road traffic accident. Initial CT abdomen shows a Grade II splenic laceration with no active extravasation and he is haemodynamically stable. He is managed non-operatively. On day 5, he suddenly develops severe left shoulder-tip pain and haemodynamic instability. Repeat CT shows a large peri-splenic haematoma with active haemorrhage. Which complication has occurred?
- A Splenic vein thrombosis
- B Delayed splenic rupture ✓
- C Post-traumatic splenic pseudocyst
- D Pancreatic pseudocyst compressing the spleen
Explanation
Delayed splenic rupture occurs when an initial subcapsular haematoma expands and the splenic capsule ruptures days to weeks after the initial injury — classically between days 3 and 14. It presents with sudden haemodynamic deterioration and left shoulder-tip pain (Kehr's sign, from diaphragmatic irritation by blood). It is a recognised complication of non-operative management of blunt splenic trauma and requires urgent intervention (angioembolisation in stable patients or splenectomy if unstable). Splenic vein thrombosis causes portal hypertension, not acute haemorrhage. Post-traumatic pseudocyst develops weeks later and is not an acute event.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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