1
|
Moen M, Hamilton-Dutoit S, Steiniche T, Gude MF. B-cell hepatosplenic lymphoma presenting in adult patient after spontaneous splenic rupture followed by severe persistent hypoglycaemia: type B lactic acidosis and acute liver failure. BMJ Case Rep 2023; 16:e257154. [PMID: 38050395 PMCID: PMC10693868 DOI: 10.1136/bcr-2023-257154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 12/06/2023] Open
Abstract
A patient was admitted to hospital with splenic rupture, four 4 days after colonoscopy was performed following one month's intermittent and aggravating abdominal pain. During recovery from splenectomy, the patient developed sudden tachycardic and tachypnoea. A blood sample revealed a very low blood glucose, high lactate and acidaemia.The patient required high-dose continuous intravenous glucose, while the lactate remained elevated. Decreasing consciousness with signs of acute liver failure necessitated transfer to an advanced intensive care unit. The patient's clinical status rapidly deteriorated despite therapeutic intervention. The patient died of multiorgan failure eleven days post-splenectomy. Based on the pathology of the spleen and a post-mortem liver specimen, the patient was diagnosed with a primary extra-nodal B-cell hepatosplenic lymphoma (BCHSL) - an extremely rare form of non-Hodgkin lymphomanon.Splenic rupture followed by lactic acidosis and hypoglycaemia should lead to suspicion of a cancer-mediated Warburg effect, and prompt urgent chemotherapy.
Collapse
Affiliation(s)
- Mette Moen
- Department of Anaesthesiology, Regional Hospital Horsens, Horsens, Denmark
| | | | - Torben Steiniche
- Department of Pathology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Martin Faurholdt Gude
- Prehospital Emergency Medical Services, Research and Development, Central Denmark Region, Aarhus N, Denmark
| |
Collapse
|
2
|
Reyes-Jaimes L, Camacho-Aguilera JF. [Spontaneous splenic rupture. Case report and literature review]. Rev Med Inst Mex Seguro Soc 2023; 61:523-531. [PMID: 37540732 PMCID: PMC10484555 DOI: 10.5281/zenodo.8200591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/04/2023] [Indexed: 08/06/2023]
Abstract
Background Spontaneous splenic rupture is often life threatening due to delay in diagnosis and treatment. Abdominal pain, Kehr's sign, nausea, bloating, altered consciousness, and intestinal obstruction may be present. In larger splenic lesions, signs of peritonitis and hypovolemic shock are present. Contrast-enhanced computed tomography is the election study. Diagnosis is confirmed by negative viral serology and normal spleen on gross and histopathologic inspection. The most frequent treatment in splenectomy. Clinic case A 30-year-old male with no medical history presented with generalized abdominal pain accompanied by Kehr's sign. He is diagnosed with ruptured spleen by contrast-enhanced computed tomography and successfully treated with splenectomy. He was discharged 6 days after surgery. Conclusions Spontaneous rupture of the spleen is uncommon, but with high morbidity and mortality. It must be a differential diagnosis in the face of abdominal and/or chest pain, and the corresponding imaging studies should be carried out if the patient's conditions allow it, or their search during an exploratory laparotomy.
Collapse
Affiliation(s)
- Libertad Reyes-Jaimes
- Instituto Mexicano del Seguro Social, Hospital General de Zona No. 3, Servicio de Cirugía General. San Juan del Río, Querétaro, MéxicoInstituto Mexicano del Seguro SocialMéxico
| | - José Francisco Camacho-Aguilera
- Instituto Mexicano del Seguro Social, Hospital General de Zona No. 3, Servicio de Cirugía General. San Juan del Río, Querétaro, MéxicoInstituto Mexicano del Seguro SocialMéxico
| |
Collapse
|
3
|
Labaki M, De Kock M. Atraumatic splenic rupture in a patient treated with rivaroxaban: A case report and a narrative review. Clin Case Rep 2022; 10:e6462. [PMID: 36348987 PMCID: PMC9633371 DOI: 10.1002/ccr3.6462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/27/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022] Open
Abstract
Atraumatic splenic rupture (ASR) is a rare condition mostly associated with neoplastic, infectious, and inflammatory diseases. ASR associated with drug treatment is even rarer. In this case report, we highlight an unusual complication of the direct oral anticoagulant rivaroxaban. A 64‐year‐old male patient was admitted to the emergency department with complaints of faintness and diffuse abdominal cramps. The patient had no history of recent trauma. Clinical examination revealed hemodynamic instability with a moderate response to filling and mild abdominal discomfort on palpation. His medical history included chronic hypertension, constipation, and recent atrial flutter ablation. The patient was taking amiodarone, bisoprolol, atorvastatin, and rivaroxaban. Splenic rupture was diagnosed several hours later on contrast‐enhanced abdominal computed tomography scan. Massive blood transfusions and emergency laparotomy for splenectomy were performed. Anatomopathological analysis did not reveal any neoplastic, inflammatory, or infectious causes. The patient was successfully discharged from the intensive care unit 3 days later. Clinicians must consider the possibility of ASR as a complication of rivaroxaban in patients with abdominal tenderness and hemodynamic instability. Unfortunately, clinical presentation is not always typical of a ruptured spleen. Delayed diagnosis can be life threatening or fatal. Splenectomy via laparotomy remains the best therapeutic option in cases of splenic rupture in unstable patients on direct oral anticoagulants.
Collapse
Affiliation(s)
- Marie‐Laure Labaki
- Department of Intensive CareCentre Hospitalier de Wallonie Picarde (CHwapi)TournaiBelgium
| | - Marc De Kock
- Department of Intensive CareCentre Hospitalier de Wallonie Picarde (CHwapi)TournaiBelgium
| |
Collapse
|
5
|
Iqbal SB, Chittal AR, Rao SJ, Lakra P, Bhansali D, Pyrgos G. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac211. [PMID: 35685294 PMCID: PMC9173739 DOI: 10.1093/jscr/rjac211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/20/2022] [Indexed: 11/25/2022] Open
Abstract
Spontaneous splenic rupture is a rare and life-threatening phenomenon, usually associated with an underlying infectious, inflammatory, hematological, neoplastic or rheumatologic condition. Indeterminate cell tumor is a rare neoplastic dendritic cell disorder that is poorly understood but shares immunophenotypic markers for Langerhans cells without Birbeck granules. A 73-year-old man presented with upper abdominal pain after an unwitnessed fall. Computed tomography angiography showed splenomegaly and a large ruptured splenic subcapsular hematoma. Intraoperative findings from an emergency laparotomy revealed a large hemoperitoneum and a ruptured spleen. Microscopic sections identified numerous, mostly poorly formed, small nodules classified as a proliferation of indeterminate dendritic cell tumors.
Collapse
Affiliation(s)
- Shaikh B Iqbal
- Department of Medicine, MedStar Health Internal Medicine Residency Program, Baltimore, MD, USA
| | - Abhinandan R Chittal
- Department of Medicine, MedStar Health Internal Medicine Residency Program, Baltimore, MD, USA
| | - Shiavax J Rao
- Correspondence address. Department of Medicine, MedStar Union Memorial Hospital, 201 E University Pkwy, Baltimore, MD 21218, USA. Tel: (410) 554-2284; E-mail:
| | - Pallavi Lakra
- Department of Medicine, MedStar Health Internal Medicine Residency Program, Baltimore, MD, USA
| | - Deepty Bhansali
- Clinical and Laboratory Pathology, Anatomic Pathology, MedStar Health, Baltimore, MD, USA
| | - George Pyrgos
- Pulmonology and Critical Care Medicine, MedStar Franklin Square Medical Center, Baltimore, MD, USA
| |
Collapse
|
6
|
Utsunomiya T, Sakamoto K, Tsukamoto D, Shine M, Nishi Y, Matsui T, Tamura K, Inoue H, Takai A, Ogawa K, Sunago K, Hiasa Y, Sakao N, Shigematsu H, Sano Y, Kurata M, Fukushima M, Kitazawa R, Kitazawa S, Takada Y. Ruptured metastatic liver tumor secondary to a thymoma: a case report. J Surg Case Rep 2021; 2021:rjab341. [PMID: 34408838 PMCID: PMC8364785 DOI: 10.1093/jscr/rjab341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/15/2021] [Indexed: 11/13/2022] Open
Abstract
We report a case of rupture of a synchronous metastatic liver tumor secondary to a thymoma. A 56-year-old woman was referred to our hospital with acute abdomen. Computed tomography (CT) revealed a 10 cm diameter tumor in the left lateral segment of the liver, together with ascites, which was suggestive of intra-abdominal bleeding. She was in stable condition and hemostasis was confirmed by angiography. CT also revealed a mass in the anterior mediastinum. Elective laparoscopic left lateral segmentectomy was performed to make a pathological diagnosis and for radical resection. No peritoneal dissemination was observed and the liver tumor was curatively resected. The patient subsequently underwent thymectomy. The pathological diagnoses were thymoma with the liver metastasis. Currently, at 30 months post-treatment, she has had no tumor recurrence. Rupture of a metastatic liver tumor secondary to a thymoma is a rare condition; careful preoperative management and aggressive treatment might improve the patient's prognosis.
Collapse
Affiliation(s)
- Takeshi Utsunomiya
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Katsunori Sakamoto
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Daiki Tsukamoto
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Mikiya Shine
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Yusuke Nishi
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Takashi Matsui
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Kei Tamura
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Hitoshi Inoue
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Akihiro Takai
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Kohei Ogawa
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Kotaro Sunago
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Nobuhiko Sakao
- Departments of Thoracic Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Hisayuki Shigematsu
- Departments of Thoracic Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Yoshifumi Sano
- Departments of Thoracic Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Mie Kurata
- Department of Pathology, Ehime University Proteo-Science Center and Graduate School of Medicine, Toon, Ehime, Japan
| | - Mana Fukushima
- Division of Diagnostic Pathology, Ehime University Hospital, Toon, Ehime, Japan
| | - Riko Kitazawa
- Division of Diagnostic Pathology, Ehime University Hospital, Toon, Ehime, Japan
| | - Sohei Kitazawa
- Department of Molecular Pathology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Yasutsugu Takada
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| |
Collapse
|
7
|
Chen RJ, Gillespie C, Rowcroft A, Knowles B. Splenectomy for ruptured non-small cell lung cancer metastasis: an unusual indication. ANZ J Surg 2020; 91:E332-E334. [PMID: 32997367 DOI: 10.1111/ans.16364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/17/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Reuben J Chen
- Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Carla Gillespie
- Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Alistair Rowcroft
- Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Brett Knowles
- Department of Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
| |
Collapse
|