![]() An ultrasound scan of the abdomen revealed a splenic laceration with an expanding subscapular haematoma and haemoperitoneum. Further history revealed that the patient had had an accidental fall onto a hard surface from an approximate height of 2 feet with impact on her left upper abdomen around the time of onset of the presenting symptoms. A massive transfusion protocol with transfusion of blood and blood products was initiated. Immediate resuscitation was commenced with supplemental oxygen. The repeated haemoglobin level was 3.8 g/dl. Her blood pressure dropped to 70/40 mmHg, and her pulse rate increased to 120 beats per minute with a very low volume. Eighteen hours after admission, a sudden haemodynamic collapse was witnessed. ![]() The rest of the blood investigations yielded normal results. During the ward stay, she complained of persistent symptoms for which sublingual glyceryl trinitrate was administered. The repeated ECG did not reveal any dynamic changes. Subsequently, the patient was transferred to the medical unit. Loading doses of 300 mg oral aspirin, 300 mg clopidogrel, and 40 mg atorvastatin were prescribed along with 60 mg subcutaneous enoxaparin twice a day. ![]() She was diagnosed as having unstable angina considering her persistent symptoms. The ECG showed ‘T’ inversions in inferior leads (lead II, III, and aVF). The COVID-19 rapid antigen test result was negative. There was no localized tenderness over the chest. Her cardiorespiratory parameters were stable (noninvasive blood pressure, 112/67 mmHg pulse rate, 88 per minute peripheral oxygen saturation, 98% on room air and respiratory rate, 16 per minute). She did not disclose any autonomic features, difficulty breathing, or cough with fever. This case report highlights the necessity of excluding more sinister differential diagnoses, such as underlying splenic injuries, in cases of a combination of atypical chest and left shoulder pain and trauma however trivial they may be, which might lead to considerable modifications in subsequent management and resultant favourable outcomes.Ī 39-year-old American Society of Anaesthesiology stage 1, body mass index 23 kg m -2, South Asian female presented to the ED of a District General Hospital in Sri Lanka with atypical chest pain and left shoulder pain that had lasted for 3 days. Failure to elucidate the trauma history at the onset and the electrocardiogram (ECG) findings suggestive of inferior ischaemia during the first encounter resulted in acute coronary syndrome management with antiplatelets and anticoagulants. Herein, we present an unusual case of advanced-grade splenic rupture resulting from a trivial trauma the patient presented with chest pain radiating to the left shoulder, whereas she was haemodynamically stable on admission. Clinically sinister splenic injuries following relatively minor injuries should be given closer attention, as there could be predisposing microscopic and macroscopic histological abnormalities of the spleen. In hypovolaemic patients, anaemia and hypoxia might lead to myocardial ischaemia following advanced grades of splenic injuries. Initial presentation following a splenic injury varies from mild left hypochondrial pain, radiating pain to the left shoulder, or haemodynamic instability depending on the degree of blood loss. Traumatic splenic rupture is seen in approximately 32% of blunt injuries to the abdomen, predominantly following road traffic accidents and falls. Splenic injuries might present with ambiguous symptoms such as atypical chest pain and shoulder pain, necessitating attending clinicians to have a high degree of suspicion, especially in busy units such as the emergency department (ED).Įighty percent of abdominal trauma cases in the ED involve blunt trauma. She subsequently had an uncomplicated clinical course with regular surgical follow-up. Emergency laparotomy and splenectomy were performed with simultaneous massive transfusion for a 3.5-L blood loss. One such event is presented here, wherein a late diagnosis of an advanced grade splenic injury following a trivial trauma initially presented in disguise as acute myocardial ischaemia in a previously healthy South Asian woman in her late 30s. ![]() Although splenic injury secondary to trivial trauma comprises a minor fraction of abdominal injuries, undiagnosed or delayed diagnosis may result in a complicated clinical course. ![]() The spleen is one of the most frequently injured abdominal organs during trauma, which can result in intraperitoneal bleeding of life-threatening magnitude. ![]()
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