title: Delayed splenic rupture: dating the sub-capsular hemorrhage as a useful task to evaluate causal relationships with trauma.
abstract: The aim of the paper was to perform a chronological assessment of the phenomenon of delayed rupture of the spleen, to assess the phenomenological order about the sub-capsular hematoma transformation to determine the causal relationship with trauma as hypothetical cause of death. 80 cases of blunt trauma with splenic capsular hematoma and subsequent rupture of the spleen were evaluated: 38 had an acute rupture of the spleen, 42 presented a break in days or weeks after the traumatic injury. Time between the traumatic event and delayed rupture of the spleen is within a range of time from one day to more than one month. Data recorded included age, sex, type of trauma, injury severity score, grade of splenic injury, associated intra-abdominal injuries, pathologic specimen evaluation. Immunohistochemical investigation of perisplenic hematoma or laceration was performed utilizing polyclonal antibodies anti-fibrinogen, CD61 and CD68, and showed structural chronological differences of sub-capsular hematoma. Expression of modification and organization of erythrocytes, fibrinogen, platelets and macrophages provides an informative picture of the progression of reparative phenomena associated with sub-capsular hematoma and subsequent delayed splenic rupture. Sub-capsular splenic hematoma dating, which we divided into 4 phases, is representing a task in both clinical practice and forensic pathology.
authors.affiliation: Department of Forensic Pathology, University of Foggia, Ospedale "C. D'Avanzo", Viale degli Aviatori, 1, Foggia, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Riezzo
authors.affiliation: Department of Forensic Pathology, University of Foggia, Ospedale "C. D'Avanzo", Viale degli Aviatori, 1, Foggia, Italy.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Di Battista
authors.affiliation: Institute of Legal Medicine, University of Verona, Ospedale Borgo Trento, Verona, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: De Salvia
authors.affiliation: Department of Forensic Pathology, University of Foggia, Ospedale "C. D'Avanzo", Viale degli Aviatori, 1, Foggia, Italy.
authors.forename: Santina
authors.initials: S
authors.lastname: Cantatore
authors.affiliation: Department of Forensic Pathology, University of Foggia, Ospedale "C. D'Avanzo", Viale degli Aviatori, 1, Foggia, Italy.
authors.forename: Margherita
authors.initials: M
authors.lastname: Neri
authors.affiliation: Department of Forensic Pathology, University of Foggia, Ospedale "C. D'Avanzo", Viale degli Aviatori, 1, Foggia, Italy.
authors.forename: Cristoforo
authors.initials: C
authors.lastname: Pomara
authors.affiliation: Department of Forensic Pathology, University of Foggia, Ospedale "C. D'Avanzo", Viale degli Aviatori, 1, Foggia, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Turillazzi
authors.affiliation: Department of Forensic Pathology, University of Foggia, Ospedale "C. D'Avanzo", Viale degli Aviatori, 1, Foggia, Italy; Department of Forensic Pathology, Sapienza University of Rome, Rome, Italy. Electronic address: vfinesc@tin.it.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Fineschi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D004912:Erythrocytes / Q000473:pathology; D005260:Female; D005337:Fibrin / Q000378:metabolism; D005340:Fibrinogen / Q000378:metabolism; D049429:Forensic Pathology; D006406:Hematoma / Q000473:pathology; D006470:Hemorrhage / Q000473:pathology*; D006485:Hemosiderin / Q000378:metabolism; D006801:Humans; D007150:Immunohistochemistry; D022125:Lacerations; D008264:Macrophages / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000473:pathology; D010974:Platelet Aggregation; D012189:Retrospective Studies; D013154:Spleen / Q000378:metabolism / Q000473:pathology; D013158:Splenic Diseases / Q000473:pathology*; D013161:Splenic Rupture / Q000473:pathology*; D013194:Staining and Labeling; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000473:pathology
chemical_list: D005337:Fibrin; D005340:Fibrinogen; D006485:Hemosiderin
keywords: Delayed splenic rupture; Histological age determination; Sub-capsular hematoma; Trauma