Mechanisms of delayed splenic rupture: a new hypothesis.
A 46-year-old man was assaulted with a club to the face, chest and abdomen. On admission there were no signs of circulatory shock. The abdominal examination was unremarkable. During his stay in hospital he had light diets. He was managed symptomatically and discharged 5 days after the incident. Two hours after discharge he was admitted again with a complain of severe abdominal pain. Immediately after a heavy diet, he experienced this abdominal pain. On admission, he was pale with features of circulatory shock. There was a marked tenderness with rigidity and guarding on abdominal palpation. Without a proper diagnosis he was pronounced dead 13 h after admission. Autopsy revealed a haemoperitoneum. A haematoma was seen overlying a splenic laceration on the gastric area of the visceral surface. The body of the empty stomach was in contact with this haematoma. Histological examination confirmed the perisplenic haematoma of otherwise normal spleen. The pressure exerted by full stomach after heavy solid meals may disturb perisplenic haematoma overlying a laceration on the gastric surface of the spleen causing delayed splenic rupture leading to sudden fatal intraperitoneal haemorrhage.
Kodikara
Sarathchandra
S
Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. kaskodikara@yahoo.com
Sivasubramanium
Murugapillei
M