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Martelo R, Morais JC, Rábago A, Borges IC, Rodrigues F. A Rare Case of Atraumatic Splenic Rupture Due to Chronic Pancreatitis. Cureus 2021; 13:e19936. [PMID: 34966620 PMCID: PMC8711260 DOI: 10.7759/cureus.19936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/06/2022] Open
Abstract
Atraumatic splenic rupture is a rare but dangerous complication of chronic pancreatitis, vastly ignored in emergency literature. The anatomical relationship between the spleen and the tail of the pancreas contributes to the pathophysiology when an inflammatory process is in progress, although the mechanisms are not fully understood. The authors report the case of a 41-year-old male, previously undiagnosed with chronic pancreatitis, presenting with atraumatic splenic rupture. Due to worsening abdominal pain and hemodynamic instability, he underwent total splenectomy. The final diagnosis was obtained through contrast-enhanced abdominal computed tomography scans, intraoperative findings and histopathological examination of the surgical specimen, as frequently reported in previous cases. Total splenectomy is the treatment of choice, as the failure rate of the conservative approach is high. Few of these cases are described and a deeper understanding of the subject is needed. As this condition can worsen in a short time, a prompt diagnosis followed by adequate treatment can impact the morbidity and mortality associated with splenic rupture. High clinical suspicion is essential and increased knowledge about the pathophysiology and presentation of splenic complications in pancreatitis may alert emergency physicians to these fatal complications.
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Affiliation(s)
- Rita Martelo
- General Surgery, Hospital Vila Franca de Xira, Vila Franca de Xira, PRT
| | - João C Morais
- General Surgery, Hospital Vila Franca de Xira, Vila Franca de Xira, PRT
| | - Angeles Rábago
- General Surgery, Hospital Vila Franca de Xira, Vila Franca de Xira, PRT
| | - Inês C Borges
- General Surgery, Hospital Vila Franca de Xira, Vila Franca de Xira, PRT
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2
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Nadaraja R, Yahya Z, Mori K, Aly A. Atraumatic splenic rupture in patient with acute pancreatitis. BMJ Case Rep 2021; 14:14/3/e238559. [PMID: 33758040 PMCID: PMC7993292 DOI: 10.1136/bcr-2020-238559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Atraumatic splenic rupture (ASR) is a rare complication of acute pancreatitis with high mortality and morbidity rates. We present a case of a 63-year-old woman with a history of hypertension, presenting with acute pancreatitis who subsequently developed a splenic rupture requiring a laparotomy and splenectomy. ASR is a rare but life-threatening complication requiring prompt recognition and management and should be considered in patient with pancreatitis who develops sudden haemodynamic compromise and worsening anaemia.
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Affiliation(s)
| | - Zarif Yahya
- Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Krinal Mori
- Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Ahmad Aly
- Surgery, Austin Health, Heidelberg, Victoria, Australia
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3
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Jain D, Lee B, Rajala M. Atraumatic Splenic Hemorrhage as a Rare Complication of Pancreatitis: Case Report and Literature Review. Clin Endosc 2019; 53:311-320. [PMID: 31337192 PMCID: PMC7280842 DOI: 10.5946/ce.2019.087] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/10/2019] [Indexed: 12/21/2022] Open
Abstract
Splenic hemorrhage (hematoma and rupture) is a rare complication of pancreatitis. In this article, we present a rare case of spontaneous splenic rupture as a complication of acute pancreatitis. A literature review was also completed to describe the patient characteristics, associated pancreatitis etiology, clinical presentations, risk factors, diagnostic and treatment modalities, and outcomes.
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Affiliation(s)
- Deepanshu Jain
- Division of Gastroenterology, Department of Digestive Diseases and Transplantation, Albert Einstein Healthcare Network, Philadelphia, PA, USA
| | - Byeori Lee
- Department of Internal Medicine, Albert Einstein Healthcare Network, Philadelphia, PA, USA
| | - Michael Rajala
- Division of Gastroenterology, Department of Digestive Diseases and Transplantation, Albert Einstein Healthcare Network, Philadelphia, PA, USA
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4
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Xie CL, Zhang M, Chen Y, Hu R, Tang MY, Chen TW, Xue HD, Jin ZY, Zhang XM. Spleen and splenic vascular involvement in acute pancreatitis: an MRI study. Quant Imaging Med Surg 2018; 8:291-300. [PMID: 29774182 DOI: 10.21037/qims.2018.03.04] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background To investigate the spleen and splenic vascular involvement in acute pancreatitis (AP) and their correlations with the severity of AP using magnetic resonance imaging (MRI). Methods MRI of 239 patients with AP was retrospectively reviewed to assess splenic and splenic vascular complications, and the severity of AP. The severity of AP was graded by the MRI severity index (MRSI) and the New Revised Classification of AP 2012. The intravoxel incoherent motion (IVIM) parameters (D, D*, and f) of spleen were measured. Thirty-five subjects without pancreatic and splenic disorders were enrolled as controls for IVIM parameters. Results Among the 239 patients with AP, splenomegaly (16.7%), splenic infarction (0.4%), splenic vein thrombosis (4.2%), phlebitis (7.5%) and arteritis (4.2%) were observed. Splenic vascular involvement was positively correlated with the severity of AP based on both the MRSI and the New Revised Classification of AP 2012 (P<0.05). In the control and AP groups, the splenic f values were (0.164±0.074) vs. (0.210±0.095) (P=0.023) respectively. In AP patients with and without splenomegaly, f = (0.240±0.091) vs. (0.203±0.095) (P<0.001). Conclusions Splenic vascular involvement and splenomegaly were common in AP. The vascular involvement was associated with the severity of AP. This complication should be considered when severity and prognosis of AP are assessed. Quantitative analysis of the spleen with IVIM might be a useful imaging biomarker for splenic perfusion changes in AP, especially in those with splenomegaly.
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Affiliation(s)
- Chao-Lian Xie
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Mao Zhang
- Department of General Surgery, the Fourth People's Hospital of Sichuan Province, Chengdu 610021, China
| | - Yong Chen
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Ran Hu
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Meng-Yue Tang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Tian-Wu Chen
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
| | - Hua-Dan Xue
- Radiology Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100000, China
| | - Zheng-Yu Jin
- Radiology Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100000, China
| | - Xiao-Ming Zhang
- Sichuan Key Laboratory of Medical Imaging and Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China
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Bogner R, Resch H, Mayer M, Lederer S, Ortmaier R. Rupture of the spleen following thoracoscopic spine surgery in a patient with chronic pancreatitis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24 Suppl 4:S569-72. [PMID: 25501876 DOI: 10.1007/s00586-014-3724-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 12/07/2014] [Accepted: 12/08/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To highlight the perioperative risk of intracapsular haematoma of the spleen or splenic ruptures during thoracoscopic spine surgery in patients with chronic pancreatitis. METHODS A 38-year-old patient with an L1 burst fracture (AO A3.3) underwent a standard thoracoscopic corpectomy and replacement of the vertebral body with an extendable vertebral body replacement 10 days after posterior instrumentation of T12-L2. In patients history chronic abusive alcoholism with related diseases such as pancreatitis, followed by hemipancreatectomy was found. Six hours after the surgery, the patient became hemodynamically unstable. An emergency CT scan revealed a splenic rupture. Emergent splenectomy was performed. RESULTS After surgical treatment of the L1 burst fracture, a rupture of the spleen was detected. An immediate splenectomy was performed. At the 18-month follow-up, an unchanged stable position of the cage was observed on CT. CONCLUSIONS Due to its proximity to the thoracolumbar junction, the spleen is vulnerable to injury during spine surgery. If the patient has undergone previous intra-abdominal operations or chronic inflammation of the pancreas is found, special care of the spleen during the operation is necessary.
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Affiliation(s)
- Robert Bogner
- Department of Traumatology and Sports Injuries, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020, Salzburg, Austria,
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6
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Sawrey M, Hughes RG. An interesting cause of collapse in a patient with chronic pancreatitis. BMJ Case Rep 2013; 2013:bcr-2013-009168. [PMID: 23697449 DOI: 10.1136/bcr-2013-009168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 55-year-old man attended the emergency department following an episode of collapse. He was known to have chronic pancreatitis and a pancreatic pseudocyst. He had recently been recumbent due to chronic abdominal pain. On arrival he was unwell. Baseline observations revealed an oxygen saturation of 87% on room air, pulse 115 bpm and blood pressure 86/57 mm Hg. Physical examination was unremarkable except for mild abdominal tenderness. He was started on high-flow oxygen, intravenous fluid and broad-spectrum antibiotics. A chest x-ray was unremarkable. Massive pulmonary embolus was considered a likely diagnosis. The patient underwent an urgent CT pulmonary angiogram (CTPA). As this was undertaken as an urgent investigation straight from the resuscitation area a d-dimer test was not performed. The CTPA showed no evidence of pulmonary embolism but demonstrated a subdiaphragmatic collection. An arterial phase abdominal CT scan was thus performed, which confirmed a large subcapsular splenic haematoma and splenic vein thrombosis. The patient was resuscitated with blood products and transferred for splenic artery embolisation.
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Affiliation(s)
- Michael Sawrey
- Department of Emergency, Stepping Hill Hospital, Stockport, Cheshire, UK.
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Sueyoshi Y, Yoshio T, Ito M, Suemura S, Araki M, Mitsuta C, Ota M, Ohta T, Hasegawa H, Tatsumi K, Toyama T, Nakazuru S, Kuzushita N, Tsujie M, Miyamoto A, Nakamori S, Kodama Y, Mita E. A case of spontaneous splenic rupture during chemotherapy for B-cell chronic lymphoid leukemia. Clin J Gastroenterol 2012; 5:42-6. [PMID: 26181874 DOI: 10.1007/s12328-011-0272-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 10/22/2011] [Indexed: 11/28/2022]
Abstract
Spontaneous splenic rupture is a life-threatening disease and an important differential diagnosis of acute abdomen. Early clinical diagnosis and rapid intervention is required to ensure patient survival. Spontaneous splenic rupture may be induced by hematological, inflammatory or infiltrative diseases affecting the spleen. Splenomegaly may also significantly increase the risk of rupture. Other contributory factors include male, adulthood, rapid growth of the spleen and splenic abscess. Here, we present the case of a 69-year-old man who was undergoing chemotherapy for B-cell chronic lymphoid leukemia. He was admitted to our hospital after he suddenly developed persistent upper abdominal pain. Computed tomography and ultrasonography revealed accumulation of free fluid in and around the spleen. He was diagnosed as having spontaneous splenic rupture and an emergency operation was performed. During the operation, we found a massively enlarged spleen with several capsular tears, and performed a splenectomy. The patient made a good recovery. Pathological examination revealed that the spleen was infiltrated by CD20-, CD5- and CD23-positive lymphoid blasts. We encountered a case of spontaneous splenic rupture in a patient receiving chemotherapy for exacerbating B-cell chronic lymphoid leukemia. In a case of abdominal pain of acute onset in patients with hematological disease, spontaneous splenic rupture should be suspected.
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Affiliation(s)
- Yuka Sueyoshi
- Department of Gastroenterology and Hepatology, Osaka National Hospital, 2-1-14 Houenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Toshiyuki Yoshio
- Department of Gastroenterology and Hepatology, Osaka National Hospital, 2-1-14 Houenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan.
| | - Mari Ito
- Department of Gastroenterology and Hepatology, Osaka National Hospital, 2-1-14 Houenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Shigeki Suemura
- Department of Gastroenterology and Hepatology, Osaka National Hospital, 2-1-14 Houenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Manabu Araki
- Department of Gastroenterology and Hepatology, Osaka National Hospital, 2-1-14 Houenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Chiaki Mitsuta
- Department of Gastroenterology and Hepatology, Osaka National Hospital, 2-1-14 Houenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Makiyo Ota
- Department of Gastroenterology and Hepatology, Osaka National Hospital, 2-1-14 Houenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Takashi Ohta
- Department of Gastroenterology and Hepatology, Osaka National Hospital, 2-1-14 Houenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Hiroko Hasegawa
- Department of Gastroenterology and Hepatology, Osaka National Hospital, 2-1-14 Houenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Kaori Tatsumi
- Department of Gastroenterology and Hepatology, Osaka National Hospital, 2-1-14 Houenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Takashi Toyama
- Department of Gastroenterology and Hepatology, Osaka National Hospital, 2-1-14 Houenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Shoichi Nakazuru
- Department of Gastroenterology and Hepatology, Osaka National Hospital, 2-1-14 Houenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Noriyoshi Kuzushita
- Department of Gastroenterology and Hepatology, Osaka National Hospital, 2-1-14 Houenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
| | - Masanori Tsujie
- Department of Surgery, Osaka National Hospital, Osaka, Japan
| | | | - Shoji Nakamori
- Department of Surgery, Osaka National Hospital, Osaka, Japan
| | | | - Eiji Mita
- Department of Gastroenterology and Hepatology, Osaka National Hospital, 2-1-14 Houenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan
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Amonkar SJ, Kumar EN. Spontaneous rupture of the spleen: three case reports and causative processes for the radiologist to consider. Br J Radiol 2009; 82:e111-3. [PMID: 19451309 DOI: 10.1259/bjr/81440206] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Splenic rupture is most commonly encountered after blunt abdominal trauma. Atraumatic spontaneous splenic rupture is a rarer entity and can occur in both histologically normal and diseased spleen. It has a high morbidity, as there is often little or no clinical history to suggest its presence, and is generally diagnosed after imaging. We describe three experiences of spontaneous splenic rupture at our institution and discuss possible causes for the radiologist to consider.
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Affiliation(s)
- S J Amonkar
- Department of Radiology, Royal Blackburn Hospital, Haslingden Road, Blackburn BB2 3HH, UK.
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Abstract
OBJECTIVE To report the use of proximal splenic artery embolization for management of spontaneous splenic rupture. DESIGN Case report and literature review. SETTING A tertiary pediatric critical care unit in a university teaching hospital. INTERVENTIONS Proximal splenic artery embolization. MEASUREMENTS AND MAIN RESULTS An 8-yr-old boy presented with abdominal pain radiating to the left shoulder 9 days after completing induction chemotherapy for acute lymphoblastic leukemia. Imaging revealed a splenic rupture with parenchymal and subcapsular hematomas, with no evidence of active extravasations. The patient was admitted to the pediatric critical care unit for close hemodynamic monitoring and frequent measurements of hemoglobin. His lowest recorded hemoglobin and hematocrit were 63 g/L and 0.19 L/L, respectively. Posttransfusion of packed red blood cells, he was taken to interventional radiology for proximal splenic artery embolization under moderate sedation. Several coils were successfully placed in the proximal splenic arterial system resulting in a marked reduction of splenic blood flow without disruption of collaterals. The patient recovered well from proximal splenic artery embolization in the pediatric critical care unit and experienced short lasting abdominal pain and fever for 1 day. He was discharged home 4 days after the procedure and follow-up imaging showed resolving hematomas with preserved splenic blood flow. CONCLUSION Proximal splenic artery embolization in children may be a safe therapeutic alternative to either conservative or surgical management in spontaneous splenic rupture. Preservation of splenic tissue with a reduced risk of repeated hemorrhage can be obtained with proximal splenic artery embolization.
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Rhee SJ, Sheena Y, Imber C. Spontaneous rupture of the spleen: a rare but important differential of an acute abdomen. Am J Emerg Med 2008; 26:733.e5-6. [PMID: 18606341 DOI: 10.1016/j.ajem.2007.11.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Accepted: 11/01/2007] [Indexed: 11/19/2022] Open
Abstract
Spontaneous rupture of the spleen, although previously documented, is a rare phenomenon. It commonly occurs in a pathologic spleen, usually owing to hematological manifestation. We describe a rare incident of spontaneous splenic rupture presenting to an emergency department as a first manifestation. The purpose of this case report is to highlight the importance of considering spontaneous rupture of the spleen as a rare but important differential of an acute abdomen.
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Affiliation(s)
- Shin-Jae Rhee
- Department of Surgery, University College London Hospital NHS Trust, NW3 2YT London, UK.
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11
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[An unusual complication of chronic pancreatitis]. Internist (Berl) 2007; 49:97-100. [PMID: 18060333 DOI: 10.1007/s00108-007-1982-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Atraumatic rupture of the spleen is a rare, but life-threatening complication of pancreatitis. We report a case of an atraumatic spleenic rupture in chronic pancreatitis. A 41 year old man presented in the emergency room with abdominal pain and typical signs of acute pancreatitis. His medical history showed a chronic pancreatitis due to alcoholism with recurrent acute pancreatitic episodes. He denied any trauma in the recent past. In the next few hours he showed clinical signs of a severe hemorrhagic shock. The haemoglobin level fell from 9.4 to 3.0 g/dl. Abdominal ultrasound and abdominal CT scan showed free fluid. In the following laparotomy a splenectomy was performed due to splenic rupture. A histological examination of the spleen revealed no reason, that could explain the splenic rupture. Hence we assumed a spontaneous rupture. The reported case demonstrates that in acute pancreatitis and signs of shock it is necessary to rule out rupture of the spleen e.g. via ultrasound and abdominal CT scan. If there are signs of spleenic rupture, the only therapy of this life-threatening complication is instant operation to save patient's life.
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12
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Ortega Carnicer J. [Spontaneous splenic rupture as a complication of acute pancreatitis]. Med Intensiva 2006; 30:474-5. [PMID: 17194406 DOI: 10.1016/s0210-5691(06)74572-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Biswas S, Keddington J, McClanathan J. Large B-cell lymphoma presenting as acute abdominal pain and spontaneous splenic rupture; a case report and review of relevant literature. World J Emerg Surg 2006; 1:35. [PMID: 17129392 PMCID: PMC1712221 DOI: 10.1186/1749-7922-1-35] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 11/28/2006] [Indexed: 11/20/2022] Open
Abstract
Background Spontaneous rupture of the spleen is an uncommon dramatic abdominal emergency that requires immediate diagnosis and prompt surgical treatment to ensure the patients survival. Infections have been cited in most cases involving splenic rupture but are rare in hematological malignancies despite frequent involvement of the spleen. Methods and Materials We present a case of a splenic rupture caused by infiltration of B-cell lymphoma. A 43 year old gentleman presented with a 1 day h/o left upper quadrant pain; nausea and vomiting for 2 days with associated dizziness and anorexia. The CT showed abnormal spleen 20 × 11 cm with free fluid in the abdomen and enlarged retroperitoneal LNs. The patient underwent a splenectomy after initial resuscitation and the operative finding was that of a massively enlarged spleen with areas of tumor extruding through the splenic capsule. Result and conclusion Although the spleen is often involved in hematological malignancies, splenic rupture is an infrequent occurrence. In a recent literature review 136 cases were of splenic rupture secondary to hematological malignancy were identified. Acute leukemia and non Hodgkin lymphoma were the frequent causes followed by chronic myelogeneous leukemia. Male sex, adulthood, severe splenomegaly and cytoreductive chemotherapy were factors more often associated with splenic rupture. Emergency splenectomy remains the cornerstone treatment for splenic rupture. We present a case report of a "spontaneous splenic rupture" and discuss the presentation, etiology and treatment options along with discussion of relevant literature
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Affiliation(s)
- Saptarshi Biswas
- Department of General Surgery, Stanford University Medical Center. 300 Pasteur Drive, Palo Alto, CA- 94305. USA
| | - Judith Keddington
- Department of General Surgery, Kaiser Permanente, 900 Kiely Blvd. Santa Clara. CA95051. USA
| | - James McClanathan
- Department of General Surgery, Kaiser Permanente, 900 Kiely Blvd. Santa Clara. CA95051. USA
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Rahili A, Karimdjee BS, Hastier P, Myx A, Juwid A, Benchimol D, Bourgeon A. [Spontaneous rupture of the spleen in chronic calcifying pancreatitis: report of three cases]. GASTROENTEROLOGIE CLINIQUE ET BIOLOGIQUE 2005; 29:604-6. [PMID: 15980759 DOI: 10.1016/s0399-8320(05)82137-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Spontaneous rupture of the spleen is a rare complication of chronic calcifying pancreatitis. Anemia and hemorrhagic shock may not occur, making diagnosis more difficult. Favourable response to conservative treatment does not prevent the need for splenectomy, as calcifiying chronic pancreatitis may progress locally. We report three cases of spontaneous rupture of the spleen. In two cases, splenic rupture revealed calcifying chronic pancreatitis and both patients underwent urgent splenectomy. In the third case, the patient was known to have calcifying chronic pancreatitis, and splenectomy was performed because of unsuccessful conservative treatment. We discuss the role of distal pancreatectomy during splenectomy to reduce the rate of postoperative complications and additional surgery. We also discuss the role of arterial embolisation and laparoscopy in the management of this rare condition.
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Affiliation(s)
- Amine Rahili
- Service de Chirurgie Générale et Cancérologie Digestive, Hôpital Archet II, Université Nice Sophia Antipolis, route de Saint-Antoine-de-Ginestière.
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15
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Affiliation(s)
- A K Choudhury
- General Surgical Department, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool FY3 8NS, UK.
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Adelekan MO, Nasmyth DG, Joglekar VM. Acute pancreatitis presenting as a case of splenic rupture. HOSPITAL MEDICINE (LONDON, ENGLAND : 1998) 2003; 64:432-3. [PMID: 12886858 DOI: 10.12968/hosp.2003.64.7.2284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A31-year-old woman, who had experienced some epigastric pains 10 days earlier, presented acutely with upper abdominal pain of 24 hours duration. There was associated nausea and vomiting. She had a past history of depression and excess alcohol consumption. Her only medication was ibuprofen for joint pains.
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Affiliation(s)
- M O Adelekan
- Department of Surgery, Furness General Hospital, Barrow-in-Furness LA14 4LF
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17
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Ghobrial MW, Karim M, Mannam S. Spontaneous splenic rupture following the administration of intravenous heparin: case report and retrospective case review. Am J Hematol 2002; 71:314-7. [PMID: 12447963 DOI: 10.1002/ajh.10214] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We report the case of a 40-year-old African-American female who presented to the Emergency Department with unstable angina. The patient, who had multiple risk factors for coronary artery disease, was admitted to the coronary care unit for cardiac work-up and management. Shortly after the intravenous administration of unfractionated heparin, she suffered the acute onset of upper abdominal pain and shock. A CT scan of the abdomen revealed splenic rupture with hemoperitoneum. The patient, who was managed surgically, had complete recovery before discharge. A review of systems and medical records revealed no obvious risk factors or other potential etiology for this rupture. We herein provide the characteristics of this rarely documented causal relationship between heparin and spontaneous splenic rupture and retrospectively review similar cases in the literature.
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Affiliation(s)
- Michel W Ghobrial
- Mercy Catholic Medical Center, Department of Medicine, Mercy Fitzgerald Hospital/Mercy Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
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18
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Ramos Ramos JC, García Díaz JDD. [Spontaneous splenic rupture as a complication of acute pancreatitis]. Med Clin (Barc) 2002; 119:478-9. [PMID: 12385664 DOI: 10.1016/s0025-7753(02)73465-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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Gupta R. Rupture of a previously normal spleen in association with enoxaparin: an unusual cause of shock. J Emerg Med 2002; 22:421; author reply 421. [PMID: 12113858 DOI: 10.1016/s0736-4679(02)00444-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hernández-Siverio González N, Pérez Palma J, Miguel Márquez A, Díaz Flores L. Rotura espontánea esplénica relacionada con enfermedad pancreática. Cir Esp 2002. [DOI: 10.1016/s0009-739x(02)72072-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Burg MD, Dallara JJ. Rupture of a previously normal spleen in association with enoxaparin: An unusual cause of shock. J Emerg Med 2001; 20:349-52. [PMID: 11348813 DOI: 10.1016/s0736-4679(01)00310-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We report the case of an adult male presenting in shock caused by spontaneous rupture of a pathologically normal spleen. One day before his presentation he had received a single subcutaneous injection of enoxaparin. This was the patient's only clearly identifiable risk factor for spontaneous splenic rupture. Nontraumatic splenic rupture should be included in the differential diagnosis of shock.
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Affiliation(s)
- M D Burg
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Weiss SJ, Smith T, Laurin E, Wisner DH. Spontaneous splenic rupture due to subcutaneous heparin therapy. J Emerg Med 2000; 18:421-6. [PMID: 10802418 DOI: 10.1016/s0736-4679(00)00157-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We report a case of spontaneous splenic rupture in a 59-year-old woman who was receiving 15,000 units of heparin subcutaneously (s.c. ) twice a day for deep venous thrombosis (DVT) prophylaxis. Her past medical history included multiple DVT, pulmonary emboli, and ovarian cancer stage III-C with known ascites. The diagnosis of splenic rupture was initially missed because of the ascites. This case illustrates both a previously undescribed complication of s.c. heparin therapy and a failure of ultrasound diagnosis. We emphasize the unique presentation, difficulty in diagnosis, and need for early surgical involvement to ensure the most favorable outcome.
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Affiliation(s)
- S J Weiss
- Division of Emergency Medicine, University of California, Davis, Medical Center, Sacramento, California 95817, USA
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