A case of laparoscopic assisted ileostomy reduction after multiple abdominal injuries / 中国综合临床

Patients with abdominal surgery history always present different degrees of abdominal adhesion. In the past, it was regarded as a relative contraindication of laparoscopic surgery. With the development of minimally invasive concept, reoperative minimally invasive surgery is proposed in clinic to avoid huge trauma caused by multiple open surgeries. In June 2022, a laparoscopic assisted ileostomy reduction was performed for a patient with history of multiple abdominal injuries in Shanghai Changzheng Hospital. Minimally invasive achieved after huge trauma, and it maximized the benefit to the patient.

Accidental Blunt Abdominal Injury Causing Multiple Small Bowel Loops’ Avulsion from the Mesentery and Dismembered Colon

A 50-year-old male, truck driver, met with an accident with blunt steering wheel injury to the abdomen with no external marks ofinjury over the abdominal wall. He had severe abdominal pain with tossing up in bed. As the abdomen showed no external marksof injuries, strikingly, abdominal palpatory findings were prominent with severe tenderness in the left side umbilical and pelvicregions. He had consumed heavy food with liquids within an hour before the accident. He collided with another stationary lorry;thus, he received massive blow to his abdomen with the steering wheel. He displayed the signs of hemorrhagic shock on arrivalto the emergency care. Computed tomography scan confirmed moderate hemoperitoneum with multiple bowel perforations. Onexploratory laparotomy, multiple jejunal and ileal loops were found completely avulsed from the base of the mesentery, makingthem completely devascularized along with dismembered descending colon from the sigmoid. Resection of nonviable smallbowels and end-to-end jejunoileal anastomosis was done. Colocolic anastomosis was performed after adequate descendingcolon mobilization with protective loop ileostomy in the right lower quadrant. The patient had developed wound infection; hence,he was put on daily dressing. Gradually, the patient improved and was discharged with functioning ileostomy.

Study of the Medicolegal Aspects of Traffic Accident Cases in North Bihar

Traffic accidents have become one of the leading causes of death in recent times. Out of all types of accidents confronting the mankind, traffic accidents claim a major share and the morbidity and mortality due to these is progressively on increase. On a general analysis, several factors seem to be responsible for causing these accidents on the roads including errors on the part of the drivers of the vehicles, the pedestrians or victims, lack of proper traffic system, mechanical defects or failures in the vehicles, bad condition of the roads, overcrowding and encroachment of the main roads or junctions and poor visibility on the pathways. The present study is aimed to assess the magnitude of the problem in northern part of the state. Methods: The present work was carried out categorising subjects into two groups. The first group was of those victims bought directly to the mortuary from the site of accident and the second group of those victims who succumbed due to injuries received in the accident in course of treatment in the hospital and later brought to mortuary for autopsy. A case-sheet was prepared for each individual case and all information as per the proforma were noted in it. Results: In the present series, a study of 75 cases of traffic accidents have been made. These cases accounted for 23.43% of total medicolegal autopsies conducted in the department during the period. This figure indicated that fatal traffic accidents have a considerable share among all unnatural deaths. Conclusion: The present study revealed that traffic accidents take a heavy toll of human lives in this region. Being preventable this should be given due consideration by public health authorities, all the members of medical profession, road safety authorities, legislators and other concerned persons. All the safety measures to prevent these should be evaluated from time to time so that the problems could be highlighted and newer methods employed for safe guarding majority of the population at risk from falling prey of these.

Review of the Clinical Characteristics of Adrenal Gland Injury Following Blunt Trauma in a Single Institution

PURPOSE: Adrenal gland injuries in trauma are rare and usually misdiagnosed or underestimated in an emergency setting because they are asymptomatic and associated with severe abdominal injuries. This paper reviews the clinical characteristics of adrenal injuries. METHODS: A retrospective analysis of trauma patients who visited the authors' emergency center was performed from March, 2010 to December, 2017. The patient demographic data, injury mechanism & associated injuries, injury severity score, hospital stay, and mortality were retrieved and analyzed. RESULTS: Adrenal gland injuries were found in 52 patients: 73.1% (n=38) were males and the mean age was 43.6 years. Of the patients, 84.6% (n=44) had ISS ≥15. Right adrenal gland injuries occurred in 82.7% (n=43). The mechanism of injury was falls in 30.8% (n=16), motor vehicle accidents in 25.0% (n=13), and pedestrian accidents in 23.1% (n=12). Associated injures were liver injury (58.5%), rib fracture (52.8%), kidney injury (24.5%), pelvic bone fracture (20.8%), spine fracture (28.3%), and spleen injury (13.2%). The mean hospital stay was 34.2 days, and the intensive care unit stay was 9 days. The mortality rate was 3.8% (n=2). CONCLUSION: Adrenal gland injuries are common in males and frequent in the right side. Falls are the leading cause of injury. Most injuries have an associated injury at the abdominal or thoracic region. Adrenal injury is accompanied by high injury severity but showed a good prognosis.

Interventional treatment experience in multiple injury with major abdominal or pelvic injuries: 160 cases analysis / 中华创伤杂志(英文版)

<p><b>PURPOSE</b>To observe the therapeutic effect of interventional embolization and haemorrhage control in multiple trauma patients with a major abdominal or pelvic injury.</p><p><b>METHODS</b>Data of 160 multiple trauma patients with a major abdominal or pelvic injury were retrospectively analyzed. They were admitted into the Department of Emergency of the First Affiliated Hospital of Zunyi Medical College from October 2013 to April 2016. Eighty-seven patients who received emergent intervention for embolization and haemorrhage control were set as group A, including 72 males and 15 females, with an average age of (39.32 ± 14.0) years. Patients underwent emergent intervention for embolization and hemostasis. The other 73 patients who received traditional surgeries were set as group B, including 62 males and 11 females, with an average age of (38.48 ± 13.12) years. The time from admission to emergency intervention, the time of interventional embolization, transfusion during hospitalization, length of stay and prognosis were observed. The whole treatment and prognosis were compared between group A and group B.</p><p><b>RESULTS</b>In group A, the average time from admission to intervention exploration was (132.05 ± 86.80) min, the average operation time was (149 ± 49.69) min, the average hospitalization time was (18.37 ± 4.71) days, the average amount of RBC transfusion during hospitalization was (7.2 ± 4.33) units, and the mortality was 4.60% (4 patients died). The corresponding data in group B were respectively (138.95 ± 82.49) min, (183 ± 52.39) min, (22.72 ± 6.63) days, (12.23 ± 5.43) units, and 9.59% (7 cases died). There was no statistical difference in the time from admission to operation between the two groups (p > 0.05), but there was statistical difference in operation time, RBC transfusion, hospitalization time, prognosis, and mortality between the two groups (all p < 0.05).</p><p><b>CONCLUSION</b>The emergent intervention for embolization and haemorrhage control of multiple trauma patients with a major abdominal or pelvic injury and visceral organ haemorrhage has the advantages of less trauma, shorter operation time, shorter hospital stay, less blood transfusion in comparison to the traditional emergency surgeries.</p>

Observation on the effect of Omeprazole combined with operation on treatment of rupture of small intestine in closed abdominal injury / 中国生化药物杂志

Objective To explore the the effect of Omeprazole combined with operation on treatment of rupture of small intestine in closed abdominal injury.Methods From June 2014 to December 2014,64 cases in Xinchang county people's hospitalwith rupture of small intestine in closed abdominal were divided into the treatment group and the control group,32 cases in each group.The control group were treat with surgery,the treatment group were given surgery combined with Omeprazole.The total effective rate,quality of life,the recovery time of bowel sound and the echaust time in the two groups were compared.Results The total effective rate(90.6％,29/32)in the treatment group was significantly higher than that in thecontrol group(75.0％,24/32),the difference is significant(P< 0.05).The life index in the treatment group is significantly better than that in the control group(P<0.05).The recovery time of bowel sound in the treatment group(15.3±2.6)h,is shorter than that in the control group(23.8±6.8)h; the exhaust time(23.6±2.2)h in the treatment group is lower than that in the control group(32.3±4.6)h,the differencesis statistically significant(P< 0.05).Conclusion It can significantly improve the effect and postoperative indexes which omeprazole combined with surgical treatment on the treatment of rupture of small intestine in closed abdominal injury,Itshould be widely promoted.

Abdominal Tuberculosis Combined with Abdominal Trauma

Abdominal tuberculosis is a rare disease, about 5% of extra-pulmonary tuberculosis. However, the diagnosis of abdominal tuberculosis is difficult, because of its atypical symptoms and signs, and ambiguous results upon physical examination. When abdominal tuberculosis is combined with abdominal injury, the diagnosis will be especially complex. We present our experience of abdominal tuberculosis associated with abdominal trauma.

Uso de curativo a vácuo como terapia adjuvante na cicatrização de sítio cirúrgico infectado / Using vacuum therapy as an adjunctive treatment for healing of infected surgical sites

Resumo Infecções de sítios cirúrgicos com envolvimento de próteses sintéticas constituem grande desafio para tratamento. Apresentamos o caso de uma paciente com múltiplas comorbidades, histórico de enxerto aortobifemoral há 6 anos e reabordagem das anastomoses femorais por reestenoses há 5 anos. Apresentou dor inguinal esquerda e abaulamento súbitos com diagnóstico de pseudoaneurisma femoral roto e instabilidade hemodinâmica. Foi submetida a correção emergencial com interposição de prótese de dácron recoberta por prata e correção de grande hérnia incisional abdominal com tela sintética ao mesmo tempo. No pós-operatório, manteve-se por longo período sob terapia intensiva com dificuldade de extubação. Nesse ínterim, apresentou deiscência das suturas e fístula purulenta inguinal esquerda em contato com a prótese vascular. Optou-se pelo tratamento conservador, com desbridamento das feridas e aplicação de curativo a vácuo. A paciente evoluiu com melhora e cicatrização das feridas. Essa pode se constituir em ferramenta importante em casos similares.

Abstract Infections at the sites of surgery involving synthetic prostheses are challenging to treat. We present a case of a patient with multiple comorbidities who had undergone an aortobifemoral bypass 6 years previously and then re-intervention at the femoral anastomoses for restenosis 5 years previously. The patient presented with acute left inguinal pain and swelling and was diagnosed with a ruptured femoral pseudoaneurysm and hemodynamic instability. A repair was conducted by interposition of a silver-coated Dacron graft in the emergency room, and a large abdominal incisional hernia was repaired with synthetic mesh during the same intervention. After surgery, the patient remained intubated in intensive care for a long period. Meanwhile, she presented dehiscence of sutures and a left inguinal purulent fistula that was in contact with the vascular prosthesis. Conservative treatment was chosen, with debridement of wounds and vacuum therapy. The patient improved and the wounds healed. This could be an important tool in similar cases.

Application of fast track surgery during perioperative period in abdominal injury / 解放军医学杂志

Objective To explore the safety and effectiveness of fast track surgery (FTS) during perioperative period in abdominal injury. Methods Two hundred and fifty-eight patients with single-organ or tissue damage of abdomen were selected from the 59 Hospital of PLA’s Abdominal Surgery Center during Jan. 2011 and Dec. 2014. These patients were divided into FTS group (n=14l) and control group (n=117). FTS group received FTS treatment during the perioperative period, and the control group received traditional treatment. Anesthesia recovery time, extubation time, C-reactive protein (CRP) levels before and after operation (1st and 5th day), postoperative lactate clearance rate, venting and defecation time, hospital stay and cost, occurrence of adverse reactions and complications were compared between the two groups. Results All the 258 patients were cured. Compared with control group, patients in FTS group got shortened anesthesia recovery time and extubation time, lower CRP levels at 1st and 5th day after operation, higher postoperative lactate clearance rate, and markedly shortened venting and defecation time and hospital stay, and the hospital cost also decreased obviously (P0.05). Conclusion It is safe and efficient to use FTS during perioperative period in abdominal injury, and could accelerate the recovery.

Clinical Efficacy of Magnesium Isoglycyrrhizinate Combined with Routine Therapy in the Treatment of Pa-tients after Closed Abdominal Trauma Complicated with Liver Damage / 中国药师

Objective:To investigate the clinical efficacy of magnesium isoglycyrrhizinate ( MgIG) in the treatment of patients with liver damage after closed abdominal trauma. Methods:Totally 84 cases of patients with closed abdominal trauma were randomly divided into the observation group (n=42) and the control group (n=42) according to the random number table. The control group was given the conventional treatment, while the observation group was treated with MgIG additionally. The treatment course was 14d. The clinical efficacy and the level changes of albumin, prealbumin, TBiL, AST and ALT before and after the treatment in the two groups were stud-ied and compared, and the adverse reactions during the treatment course were also compared between the groups. Results: The total effective rate of the observation group (90. 48%) was significantly higher than that of the control group(69. 05%, P<0. 05). After the treatment, the plasma albumin and prealbumin levels in both groups were significantly increased (P<0. 05), and those in the ob-servation group were significantly higher than those in the control group (P<0. 05). The serum TBiL, AST and ALT levels in both groups were significantly decreased after the treatment (P<0. 05), and those in the observation group were significantly lower than those in the control group (P<0. 05). There was no serious adverse reaction during the treatment course in both groups. Conclusion:MgIG in the treatment of liver damage after closed abdominal trauma shows notable effect, which can improve liver function obviously with high safety and reliability.

Role of CT imaging in patients sustaining blunt injury of abdomen, retrospective analysis from a tertiary care hospital

Background: Blunt abdominal trauma is a frequently encountered emergency with associated significant morbidity and mortality. Since conservative nonsurgical therapy is preferred for all but the most severe injuries affecting the solid viscera, CT imaging is useful in detecting severe solid organ and bowel injuries which require surgical management. Objective: To analyze the profile of abdominal injuries presenting to the emergency medicine department of a tertiary care teaching hospital. Materials and methods: The study was a retrospective analysis of hospital records conducted in Velammal Medical College and Hospital, Madurai, which is a tertiary care teaching hospital in south India. The study was conducted from May 2014 to January 2016. People reporting to the emergency, with suspected abdominal injuries and evaluated for the same by CT abdomen were included in the study. Results: CT had 100% negative predictive value and highly specific in ruling out significant abdominal injuries. Spleen was the most common organ injured in study population, seen in 32 (42.10%) patients. The other common organs injured were liver and kidneys, which were injured in 24 (31.57%) and 16 (21.05%) patients respectively. Only 25% of the patients in our study required surgical intervention, which was for Grade IV/V splenic injuries, hepatic injury with active contrast extravasation, hepatic pseudo aneurysm, bowel and diaphragmatic injuries. Rajalakshmi Preethi G, Mariappan M, Madhusudhanan J, Arun AC. Role of CT imaging in patients sustaining blunt injury of abdomen, retrospective analysis from a tertiary care hospital. IAIM, 2016; 3(9): 79-86. Page 80 Conclusions: CT is highly useful in evaluation of hemodynamically stable patients with suspected blunt abdominal trauma. Majority of the patients with abdominal injury were successfully managed conservatively.

Diagnosis and treatment of 521 cases of abdominal trauma / 重庆医学

Objective To investigate the experience of management of abdominal injuries.Methods The data of 521 cases with abdominal injury from June 2005 to May 2012 was analyzed retrospectively.Results In 521 cases,the grade of ISS within 8-65, average 23.6.453 suffered from blunt injuries and 68 from stab penetrating injuries.Hemorrhagic shock appeared in 231 patients (44.3%).The abdominal viscera injuries occurred in 777 cases.The operability of abdominal injuries was 83.5%,associated with polytrauma in 331.The mortality rate was 6.53%(34/521),in death group,the grade of ISS on average 43.6.13 cases died of hem-orrhagic shock,and 7 died of severe craniocerebral injury,4 died of cardiac injuries,3 died of ARDS due to flail chest and Severe pul-monary infection,one died of ACS and nine died of SIRS and MODS.The incidence rate of complication related to abdominal injury was 12.3% (60/487),most of them was infection and bleeding.Conclusion All that abdominal integrity be destroyed should be ex-plored;use of damage control surgery (DCS)and do not importune to decide to surgery on the basis of organ damage grading in e-mergency;perform laparotomy could improve the treatment success rate of abdominal large vessels injury in the emergency room;pay attention to thelethal triadprecursor,and terminate the operation quickly when it happens.

Comparison between operative versus non-operative management of traumatic liver injury

BACKGROUNDS/AIMS: The aim of this study was to compare operative versus non-operative management of patients with liver injury and to ascertain the differences of the clinical features. METHODS: From April 2000 to July 2012, 191 patients were admitted to Seoul St. Mary's Hospital and St. Vincent's Hospital for liver injuries. Of these, 148 patients were included in this study. All patients were diagnosed using computed tomography (CT). The liver injury was graded in accordance with the American Association for the Surgery of Trauma liver injury scoring scale. Patients were divided into two groups: those who underwent surgery and those treated with non-operative management (NOM). There was a comparison between these two groups concerning the clinical characteristics, grade of liver injury, hemodynamic stability, laboratory findings, and mortality. RESULTS: According to the 148 patient records evaluated, 108 (72.9%) patients were treated with NOM, and 40 (27.1%) underwent surgery. Patients treated with NOM had significantly fewer severe injuries as rated using the Revised Traumatic Injury Scale, Injury Severity Score, and Glasgow Coma Scale. Grade of liver injury and number of patients with extravasation of contrast dye on CT and hemoperitoneum were higher in the operative group than in the NOM group. There were significant differences between the two groups for: heart rate, respiratory rate, systolic blood pressure, and mean hemoglobin levels at admission and after 4 hours. The operative group experienced a significantly higher mortality than the NOM group. CONCLUSIONS: The results of our study suggest that hemodynamic stability and the following should be considered for deciding the treatment for liver injuries: grade of liver injury, amount of blood loss, and injury scales scores.

Laparoscopic abdominal trauma and the diagnosis and treatment of gastrointestinal tract injury in application / 中国基层医药

Objective To explore of laparoscopic abdominal trauma used in the diagnosis and treatment of gastrointestinal tract injury.Methods 180 cases of abdominal trauma and gastrointestinal injury were randomly divided into three groups,A group of 60 cases was given conventional nonoperative treatment,B group of 90 cases was given laparoscopic exploration to surgical treatment,C group of 30 cases was open to probe the surgical treatment.The clinical effect of three groups was observed.Results After treatment,A group of recovered 32 cases,improvement in 16 cases,invalid in 12 cases,the total effective rate 80.0％,length of hospital stay (8 ±4)d,B group healed 58 cases,30 cases improved,invalid in 2 cases,the total effective rate 97.8％,length of hospital stay (8 ± 3) d,C group of 19 cases were healed,better 10 cases,1 case ineffective,the total effective rate 96.7％,length of hospital stay (15 ± 5) d,A,B and C group total effective rate differences were statistically significant (x2 =13.45,4.50,all P ＜0.05).C group hospitalization time was longer than that in A,B group (t =5.24,3.34,all P ＜ 0.05).Conclusion Laparoscopic exploration surgery for abdominal trauma and gastrointestinal injury has better diagnosis and treatment effect,which can reduce the time in hospital to improve the prognosis of patients.

Abdominal wall defect with large duodenal disruption treated by a free tissue flap with a help of temporary expandable metallic stent / 대한외과학회지

Abdominal wall defect with large duodenal disruption after penetrating abdominal injury is a rare emergency situation that can result in life-threatening complications. We report on a 64-year-old man who had abdominal wall defect with large duodenal disruption after penetrating abdominal injury. The patient presented with intra-abdominal exsanguinating bleeding, duodenal disruption, and multiple small bowel perforation. The rarity of this complex injury and its initial presentation as a posttraumatic large duodenal disruption with abdominal wall defect warrant its description. The present case indicates that combining a free tissue flap with a covered expandable metallic stent can effectively and successfully repair an abdominal wall defect that is associated with a large duodenal disruption.

FAST Reappraisal: Cross-sectional Study

PURPOSE: Focused Assessment with Sonography for Trauma (FAST) provides an important initial screening examination in adult trauma patients. However, due to its low sensitivity, FAST is not a replacement for computed tomography (CT) in hemodynamically stable trauma patients. The aim of this study was to determine the test characteristics of FAST in adult, hemodynamically stable, blunt abdominal trauma patients by using a critical action as a reference standard. METHODS: The medical records for FAST examination at a single hospital from January 2009 to February 2011 were retrospectively reviewed. The inclusion criterion was isolated, hemodynamically stable, blunt abdominal trauma. Hemodynamically unstable patients or patients with penetrating injuries were excluded. The reference standard was the presence of a critical action, which was defined as one of the following: 1) operative intervention for a finding discovered on CT, 2) interventional radiology for bleeding, 3) transfusion of 2 or more packed RBCs, or 4) death at the emergency department. RESULTS: There were 230 patients who met the inclusion criterion. There were 20 true positive, 206 true negative, 0 false positive, and 4 false negative results. The sensitivity and the specificity were 83% and 100%, respectively. CONCLUSION: Despite its low sensitivity for detecting any abnormal finding discovered on CT, negative FAST could aid to exclude critical action in hemodynamically stable, blunt abdominal trauma patients.

Delayed Splenic Rupture Following Minor Trauma in a Patient with Underlying Liver Cirrhosis

The spleen is the most frequently injured organ following blunt abdominal trauma. However, delayed splenic rupture is rare. As the technical improvement of computed tomography has proceeded, the diagnosis of splenic injury has become easier than before. However, the diagnosis of delayed splenic rupture could be challenging if the trauma is minor and remote. We present a case of delayed splenic rupture in a patient with underlying liver cirrhosis. A 42-year-old male visited our emergency department with pain in the lower left chest following minor blunt trauma. Initial physical exam and abdominal sonography revealed only liver cirrhosis without traumatic injury. On the sixth day after trauma, he complained of abdominal pain and diarrhea after eating snacks. The patient was misdiagnosed as having acute gastroenteritis until he presented with symptoms of shock. Abdominal sonography and computed tomography revealed the splenic rupture. The patient underwent a splenectomy and then underwent a second operation due to postoperative bleeding 20 hours after the first operation. The patient was discharged uneventfully 30 days after trauma. In the present case, the thrombocytopenia and splenomegaly due to liver cirrhosis are suspected of being risk factors for the development of delayed splenic rupture. The physician should keep in mind the possibility of delayed splenic rupture following blunt abdominal or chest trauma.

Death due to isolated mesenteric vascular injury following blunt abdominal trauma: A case report.

Death due to isolated injury to small bowel mesentery following abdominal trauma is rare. It is known that seatbelt trauma from motor vehicle accidents is the most common mechanism of mesenteric injury and that the mesentery of the small bowel is injured more frequently than that of the colon. Focal mesenteric infiltration associated with haemoperitoneum, particularly in the absence of solid organ injury, is highly suggestive of a mesenteric tear. In this report one such seat belt abdominal injury with subsequent mesenteric tear and bowel infarction with significant haemoperitoneum leading to death on the Operation table is being discussed. The main significance of this injury is delay and difficulty in diagnosis, especially when there is minimal signs and symptoms to warrant an exploratory laparotomy. Early detection and emergency surgical intervention when necessary are critical in improving the outcome of treatment.

Pathophysiological changes of dogs with open abdominal injury and seawater immersion-induced acute heart failure / 第二军医大学学报

Objective: To observe the pathophysiological changes of dogs with open abdominal injury and seawater immersion-induced acute heart failure. Methods: Adult mongrel dogs were randomly divided into open abdominal injury+ seawater immersion group (group A, n=8) and simple open abdominal injury group (group B, n=8). The cardiac rhythm, heart rate, systolic pressure, diastolic pressure, mean arterial pressure, pulmonary wedge pressure, central venous pressure, cardiac output, heart index, rennin, B-type brain natriuretic peptide (BNP), other relevant parameters and death rate were observed before and after open abdominal injury, during 2h seawater immersion, and at different time points after getting out of the water. The left ventiricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), stroke volumes (SV), and left ventricular ejection fraction (LVEF) were measured before and 4 h after injury by ultrasonic cardiogram. Results: The mean arterial pressure decreased significantly in group A from 5 min after injury to the end of the ovservation (P<0.05, P<0.01), and that of group B had no measurable changes. The pulmonary capillary wedge pressure (PAWP) increased significantly; the central venous pressure, cardiac output, and cardiac index decreased gradually, and continued to decrease after putting out of water,which were significantly different from those of group B(P<0.05, P<0.01). Group B had no measurable changes in PAWP, central venous pressure, cardiac output, and cardiac index before and after abdominal injury. The blood rennin and BNP levels were significantly increased in group A (P<0.05, P<0.01) and had no significant changes in group B. Conclusion: Prominent pathophysiological changes occur in rats with open abdominal injury and seawater immersion-induced acute heart failure.

Delayed Splenic Rupture with a 1-month Latent Period after Minor Trauma: A Case Report / 대한구급학회지

Delayed splenic rupture is a rare complication of blunt abdominal trauma in which the time interval from injury to splenic rupture is > 48 hours. The diagnosis can be challenging if the history of trauma is remote, or initially missed, because symptoms may present subtly and without classic historical associations. We report a case of delayed rupture of the spleen from remote, minor trauma that required an emergency splenectomy.