How should we manage a delayed presentation of blunt splenic injury?

A delayed presentation of a blunt splenic injury can refer to either an initially missed injury that manifests later with symptoms or latent insignificant injury that then becomes clinically symptomatic. This is a small patient group and there is some controversy about how these injuries should be managed. We present a case of a patient with an initially missed blunt splenic injury who represented two weeks later with hemorrhage and pain. He was treated non-operatively but returned with persistent symptoms and eventually required a difficult splenectomy. Through this case, we raise the question of whether patients who present with rebleeding in a delayed fashion from an initially missed blunt splenic injury are best treated with surgery and a splenectomy