Clinical Significance of Ruptured Intrasplenic Pseudoaneurysm and Delayed Splenic Rupture Following Splenorrhaphy for Blunt Splenic Injury

We report a case of a delayed splenic rupture secondary to the rupture of intrasplenic pseudoaneurysm in a 22-year-old man. The patient was hospitalized for blunt splenic injury after sustaing an abdominal trauma in a motorcycle accident. He underwent surgery, in which the spleen was preserved by using an absorbable polyglycolic acid mesh wrap. Postoperative abdominal ultrasonography revealed an aechoic area within the spleen. Doppler velocimetry showed arterial blood flow, and an intrasplenic pseudoaneurysm was suspected. Subsequently a definitive diagnosis of intrasplenic pseudoaneurysm was made by abdominal MRI and abdominal angiography. On the 29th day, the patient suddenly developed abdominal pain and collapsed. Emergency laparotomy was performed and splenectomy was carried out. The diagnosis of ruptured intrasplenic pseudoaneurysm was made based on the intraoperative findings. In conclusion, we advocated that transcatheter arterial embolization should be performed immediately when an intrasplenic pseudoaneurysm is found after blunt splenic injury.