Splenic Injury in Polytrauma: An Overview

Background: Splenic trauma is the most common solid organ injury in blunt abdominal trauma and is frequently encountered in polytrauma patients following road traffic accidents.(1,2,5) Contemporary management is guided by AAST and WSES classifications, with non‑operative strategies favoured in haemodynamically stable patients and splenectomy reserved for unstable, high‑grade injuries or those with peritonitis.(3,4) Delayed splenic haemorrhage, historically described as the “latent period of Baudet”, remains an important but often under‑recognised complication in patients initially managed non‑operatively.(7,8). Case presentation: A 39‑year‑old male pedestrian presented following a road traffic accident with borderline haemodynamics, generalised abdominal tenderness, guarding and a positive Kehr’s sign. Contrast‑enhanced CT demonstrated an AAST Grade IV splenic laceration with perisplenic haematoma, mild haemoperitoneum and multiple left‑sided rib fractures with a small pneumothorax. Given his clinical status and imaging, he underwent emergency laparotomy, which revealed a Grade IV splenic injury with approximately two litres of haemoperitoneum, and splenectomy was performed. His postoperative course was complicated by atelectasis and pleural effusions related to chest trauma, managed conservatively with respiratory support and physiotherapy. He was discharged in a stable condition with infectious‑disease‑guided post‑splenectomy vaccination and education regarding the risk of overwhelming post‑splenectomy infection (OPSI). (3,12–16). Results: This case illustrates guideline‑concordant operative management of high‑grade splenic injury in the setting of polytrauma, emphasising that clinical findings can override apparently reassuring CT descriptors such as “mild haemoperitoneum”.(3–6) Placed in the context of Baudet’s latent period and modern literature on delayed splenic haemorrhage, it highlights the temporal spectrum of splenic rupture—from immediate presentation with peritonitis to delayed haemorrhage weeks after trauma—and the consequent need for careful selection and follow‑up of patients undergoing non‑operative management.(6–11) The case also underscores the importance of structured post‑splenectomy care, including vaccination, patient counselling and long‑term OPSI prevention strategies in trauma populations.(12–16). Conclusion: Splenic injury remains the most common solid organ injury in blunt abdominal trauma, and in the polytrauma setting, a thorough abdominal examination is mandatory regardless of distracting skeletal injuries, as a life-threatening intra-abdominal haemorrhage must never be overlooked.(1,2,5) The latent period of Baudet serves as a critical reminder that delayed splenic haemorrhage may occur in seemingly stable patients, with the risk window extending up to and beyond 14 days from the index injury; structured clinical review and interval imaging in selected patients during this period are essential to identify evolving haematomas or pseudoaneurysms before catastrophic rupture ensues.(7,8,10,11) Every surgeon managing trauma must keep this temporal spectrum in mind alongside other differential diagnoses, as the spleen that appears safe on day one may rupture on day ten.(7–11) Post-splenectomy vaccination, patient education and long-term surveillance for overwhelming post-splenectomy infection complete the continuum of care that every splenectomised trauma patient deserves.(12–16).

Keywords: Splenic injury, blunt abdominal trauma, latent period of Baudet, polytrauma.