Delayed rupture of the spleen and streptokinase therapy.

Delayed rupture of the spleen is a rare but serious complication of blunt abdominal trauma. A 47-year-old woman with a history of fractured pelvis from a motor vehicle accident 6 months earlier presented with evidence of a myocardial infarction. Subsequent streptokinase administration was complicated by splenic rupture, which was managed by evacuation of the clotted blood and splenectomy. The patient made a complete recovery. The risk of splenic rupture and bleeding complications resulting from thrombolytic therapy for myocardial infarction is discussed, as are the controversy over whether delayed splenic rupture is a true diagnosis, the mechanism of rupture and the clues to impending rupture.