Occult Rupture of the Spleen: A Dilemma in Diagnosis

TRAUMATIC rupture of the spleen usually presents with profuse intraperitoneal bleeding that requires immediate splenectomy (85%) or may present as a delayed rupture (14%) with massive hemorrhage days to weeks after injury. Rarely (1%), splenic injury may occur without acute symptoms and may remain unsuspected and untreated for months or even years. The patient may then have a confusing variety of signs and symptoms often mistaken for angina, myocardial infarction, pulmonary embolism, intraperitoneal malignancy, or retroperitoneal sarcoma. In 1964, Lorimer 1 first reported this entity (which he called "occult rupture" of the spleen) and stressed the difficulty in establishing the diagnosis and differentiating it from neoplasia Report of a Case A 53-year-old man was admitted because of chronic epigastric and left upper quadrant abdominal pain of more than a year's duration. Recently the pain had become more severe and frequent, with radiation around the left costal margin and left flank,