Delayed Splenic Rupture Following Blunt Abdominal Injury and Its Surgical Implications

Spleen is the most common injured organ following blunt abdominal injury. Splenic injury may remain asymptomatic until delayed splenic rupture (DSR) occurs, which is a relatively rare complication. DSR mortality rate is also relatively high, mainly due to missed diagnosis or misdiagnosis. Treatment of DSR is classified into non-operative management (NOM) and surgical interventions; however, there are no clear guidelines in which approach is preferred in which situation. Thus, the aim of this review is to discuss the pathology, diagnosis, and treatment of delayed splenic rupture, highlighting its surgical implications. Multiple pathophysiological theories have been introduced to explain DSR such as delayed rupture of splenic sub-capsular hematoma, clot lysis, and rupture from a pseudoaneurysm. Ultrasound and computed tomography (CT) can be used in the diagnosing process of DSR; however, CT is considered the gold standard. NOM is useful for hemodynamically stable patients with splenic injury; however, it has been associated with various latent complications necessitating a surgical intervention eventually. Surgical intervention (e.g. splenectomy) proved its effectiveness in treating DSR. Current knowledge is largely derived from case reports, highlighting the need for larger, prospective studies to establish evidence-based guidelines for optimal management.