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Non‐operative management for ruptured splenule in haemodynamically stable patients previously splenectomized

A 33-year-old motorcyclist knocked down by a car was referred to our casualty. Thirteen years before, he was splenectomized after a similar trauma and an accessory spleen was detected in the left hypochondriac region on a subsequent computed tomography (CT) scan. At arrival in casualty, vital signs and haemogram were unremarkable: contrast-enhanced CT of the abdomen showed that the accessory spleen (9 cm in diameter) was fractured with foci of active intraparenchymal haemorrhage (Fig. 1). Repeated CT at 6 h documented persisting active bleeding and pelvic haemoperitoneum. Due to haemodynamic and haemogram stability, we opted for a close observation in intensive care unit deferring embolization or intervention to a clinical worsening which did not occur. The patient did well after the trauma and was home in 7 days without any haemotransfusion. Accessory spleen (also known as splenule or splenunculus) occurs in 10 to 30% of population as reported by autopsy studies. It develops during the fifth week of embryonic life from the failure of fusion of splenic buds: for this reason it can be single or multiple. The (a)