Precocious Diagnosis of Traumatic Splenic Rupture by Selective Coeliac Angiography

Splenic arteriography allows the organ to be clearly demonstrated and the condition of the parenchyrna to be assessed. The methode allows traumatic lesions to be easily diagnosed. The most common reliable signs are escape of contrast medium from the torn spenic arteries and lacunar appearance in the parenchyma. Other signs, such as early venous filling or antero-posterior and median displacement or deviation of the arteries are less reliable. Di­agnostic errors can result from anomalies and, in particular, from abnormal lobes with aber­rant vascularisation (polar insertion). Sub­traction is of considerable value for improving the parenchymal appearance. In 43 angiogram carried out by W. W enzetal on patients in whom the tentative diagnosis of splenic rupture had  been made, they have found no complication.  In 12 cases rupture of the spleen was found and in one case there was rupture of the liver. Surgical intervention had confirmed the diagno­sis. In two patients there was a false positive diagnosis. In the first there was a polar inser­ tion and in the ·second an aberrant lobe. In ithe light of this experence which corresponds  with ours it is possible with good technique and  prompt investigation, to establish the pre-opera­tive diagnosis in many of the cases. The method  provides a certain diagnosis for the surgeon and there is no risk to the patient.