1209 - A Case of Delayed Splenic Artery Pseudoaneurysm Rupture Identified in Acute Rehabilitation Following Nonoperative Management of Grade IV Splenic Laceration: A case report

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

SC

Stephon D. Charles, MD

Resident Physician
Westchester Medical Center
Port Chester, New York, United States
FM

Farah Maryam, MD

Resident
Westchester Medical Center
Melville, New York, United States

Co-Author(s)

MG

Merit Gorgy, MD

Resident
Westchester Medical Center
White Plains, New York, United States

Corresponding Author(s)

NG

Negin Gohari, DO

Attending
Westchester Medical Center
Valhalla, New York, United States

Submitter(s)

SC

Stephon D. Charles, MD

Westchester Medical Center
New York City, New York, United States

Case Diagnosis: Splenic pseudoaneurysm rupture

Case Description: A 33-year-old male presented to acute rehabilitation (AR) after being struck by a truck while cycling. He suffered left-sided bone fractures, including humerus, ribs, femur, tibia, and fibula fractures, and underwent open reduction and internal fixation of these injuries. The patient also had a grade IV splenic laceration that was managed nonoperatively. During AR admission two weeks after the accident, the patient presented with intractable pain despite titrated opioid pain management. He became hemodynamically unstable with tachycardia and hypotension. Further workup revealed a rupture of a splenic pseudoaneurysm (PSA) with hemorrhagic ascites and severe anemia. The patient was taken to VIR emergently for embolization of the pseudoaneurysm with a massive transfusion protocol. Post-operatively, he was hemodynamically stable and returned to AR for resumption of his rehabilitation, with significant improvement of his left-sided pain.

Discussions: High-grade splenic injuries are frequently managed nonoperatively in hemodynamically stable patients, with good overall success rates. However, delayed vascular complications, including pseudoaneurysm rupture, remain a recognized risk. In this case, the patient developed acute hemodynamic instability during rehabilitation due to rupture of a PSA and hemorrhagic ascites, a potentially fatal complication. The presentation was confounded by the patient’s extensive orthopedic injuries, including rib fractures and post-traumatic pain, underscoring the importance of maintaining vigilance for abdominal complications even outside the acute care setting. This case highlights the need for close monitoring of patients with high-grade splenic injuries, including during the rehabilitation phase, and demonstrates the value of multidisciplinary coordination for rapid recognition and management of delayed hemorrhagic complications.

Conclusions:
Delayed rupture of a PSA is a rare but life-threatening complication of high-grade splenic injury. In polytrauma patients, the diagnosis may be difficult as pain may mask signs of intra-abdominal hemorrhage. This case underscores the need for continued vigilance during rehabilitation to identify and manage delayed complications.