Splenocolonic fistula following non-operative management of splenic rupture

Abstract

Non-operative management has become the preferred treatment for splenic trauma in the absence of haemodynamic instability. The reported complications of non-operative management of splenic trauma may include pseudoaneurysm formation, delayed splenic rupture and splenic abscess formation. Splenocolonic fistula is a finding that has only previously been described in association with Crohn’s disease, pancreatitis, malignancy and haematological disorders. We present the case of a 16-year-old male who suffered a blunt traumatic injury to the spleen, was haemodynamically stable and successfully managed non-operatively. He represented 1 month later following a single episode of per-rectum bleeding. A CT scan of his abdomen revealed a pseudoaneurysm within the spleen, a splenic abscess and a splenocolonic fistula. He proceeded to emergency laparotomy for splenectomy and colonic resection and had an uneventful recovery. The history of management of blunt traumatic splenic injury is discussed, along with the associated risks of operative and conservative management. Methods predicting the success of non-operative management are explored, along with their application and relevance to this particular case.