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We appreciate the recent rethinking of the incidence of delayed rupture of the spleen through the routine use of paracentesis. Despite the reduced incidence mentioned in Dr Fischer's letter, the mechanism by which a true delayed rupture occurs is a valid one. The dilemma of an occult rupture stems from the fact that hemorrhage is tamponaded and contained by adjacent stomach, bowel, and omentum—preventing free intraperitoneal bleeding; thus, it is not amenable to diagnosis by paracentesis.
Budd DC. Occult Splenic Rupture-Reply. JAMA. 1977;237(21):2289. doi:10.1001/jama.1977.03270480029012
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