1
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Worku E, Adam Worku D. Atraumatic Splenic Rupture in Legionella pneumophila Pneumonia. Case Rep Infect Dis 2023; 2023:9625170. [PMID: 37323130 PMCID: PMC10266911 DOI: 10.1155/2023/9625170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/03/2023] [Accepted: 05/25/2023] [Indexed: 06/17/2023] Open
Abstract
A previously fit 46-year-old male handyman presented to a rural hospital with a cough, fever, and epigastric pain without peritonism. The patient was admitted medically with symptoms and radiological appearances consistent with atypical community-acquired pneumonia. During the first 48 hours of admission, he suffered a significant haemodynamic deterioration and was transferred to the intensive care unit (ICU) for vasoactive support. Following stabilisation, urgent abdominal CT imaging demonstrated splenic rupture with haematoma in the absence of historical trauma. Emergency splenectomy was performed; the histopathological examination was unremarkable. Investigations for the presenting complaint confirmed Legionella pneumophila serotype 1 pneumonia by urinary antigen testing. The patient was extubated on postoperative day 2 and stepped down from ICU to complete a 14-day course of azithromycin. Atraumatic splenic rupture is a rarely described clinical entity. The process can be subdivided into pathological and nonpathological (spontaneous) cases. Pathological atraumatic splenic rupture may occur in the context of wide-ranging aetiologies, including bacterial pneumonia; however, the association with Legionella pneumophila serotype 1 is exceptional, with this representing the eighth case in the medical literature.
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Affiliation(s)
- Elliott Worku
- Adult Intensive Care Services, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Dominic Adam Worku
- Infectious Diseases Department, Morriston Hospital, Swansea, UK
- Public Health Wales, Cardiff, UK
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2
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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] [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.
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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
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3
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ARSLAN B, HOT S, MANSUROĞLU İ. Spontaneous Spleen Rupture Due to Infectious Mononucleosis. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2022. [DOI: 10.33706/jemcr.1039130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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4
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Yağmurkaya O, Oğuz S, Kahya E, Aksoy H, Albayrak D, Sağıroğlu T. Spleen rupture due to brucellosis. Turk J Surg 2021; 37:73-75. [PMID: 34585098 DOI: 10.47717/turkjsurg.2021.3295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/10/2015] [Indexed: 11/23/2022]
Abstract
Brucellosis is a common zoonotic infection worldwide; it is caused by infection with the bacterial species Brucella and leads to severe diseases in humans and animals. In Turkey, this bacterial species has not been completely eradicated and is commonly found in animals (such as goats or sheep). Brucellosis can lead to various symptoms, affect multiple systems, and cause splenomegaly in the case of spleen involvement. In contrast to traumatic spleen ruptures, spontaneous spleen ruptures are rare and most commonly occur because of infectious causes. A 52-year-old man was treated at our infectious diseases clinic for Brucella endocarditis. Due to sudden abdominal pain, nausea, vomiting, and vertigo, the patient was evaluated by our team of doctors at the same clinic. The patient had widespread sensitivity in the abdominal region, as well as defense and rebound symptoms. Emergency abdominal tomography revealed a ruptured spleen and widespread hemorrhagic fluid in the abdomen. Exploration revealed multiple ruptures in the spleen capsule. The patient underwent splenectomy and did not experience any complications during the postoperative period. Spontaneous spleen rupture is a rare clinical condition that should be considered in patients who are hospitalized at internal medicine clinics for infectious, hematogenic, and metabolic causes, as well as in those who have sudden abdominal pain and hypovolemia.
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Affiliation(s)
- Orhan Yağmurkaya
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Serhat Oğuz
- Department of General Surgery, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Eyüp Kahya
- Clinic of General Surgery, Edirne Public Hospital, Edirne, Turkey
| | - Hüseyin Aksoy
- Clinic of General Surgery, Yozgat Public Hospital, Yozgat, Turkey
| | - Doğan Albayrak
- Department of General Surgery, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Tamer Sağıroğlu
- Department of General Surgery, Trakya University Faculty of Medicine, Edirne, Turkey
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5
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Hammond J, DeFazio J, Duron V, Wallman-Stokes A. Splenic rupture in an extremely low birthweight infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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6
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Gómez-Ramos JJ, Marín-Medina A, Lisjuan-Bracamontes J, García-Ramírez D, Gust-Parra H, Ascencio-Rodríguez MG. Adolescent With Spontaneous Splenic Rupture as a Cause of Hemoperitoneum in the Emergency Department: Case Report and Literature Review. Pediatr Emerg Care 2020; 36:e737-e741. [PMID: 29794954 DOI: 10.1097/pec.0000000000001520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Spontaneous rupture of the spleen is a rare clinical condition that usually presents as a complication of a background pathology and can become a life-threatening condition if it is not diagnosed in time. We present the case of a 15-year-old girl with abdominal pain and clinical data of hypovolemic shock. The simple tomographic study revealed deformation of the splenic architecture and hemoperitoneum. Surgery demonstrated splenic rupture with ptosis spleen and intraperitoneal free blood. The anatomopathological examination showed the presence of splenomegaly and findings suggestive of peliosis. It also highlights the known causes related to spontaneous splenic rupture.
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Affiliation(s)
| | - Alejandro Marín-Medina
- Genetics Division, Centro de Investigaciones Biomédicas de Occidente, IMSS/CUCS, Universidad de Guadalajara
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7
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Yau HCV, Pradhan S, Mou L. Atraumatic splenic rupture in a patient treated with apixaban: A case report. Int J Surg Case Rep 2020; 71:270-273. [PMID: 32480336 PMCID: PMC7264001 DOI: 10.1016/j.ijscr.2020.04.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/04/2020] [Accepted: 04/19/2020] [Indexed: 12/04/2022] Open
Abstract
Atraumatic splenic rupture should be suspected in unstable patients on direct oral anticoagulants. Splenic artery embolisation is an option for definitive therapy. Splenectomy can be utilised as salvage therapy.
Introduction Splenic rupture is often seen in the context of significant trauma. Atraumatic ruptures are described in the context of malignancy, inflammation or infection directly affecting the spleen. Splenic ruptures occurring in patients taking apixaban, a factor Xa inhibitor, are challenging due to the scarcity of a direct reversal agent. Presentation of case A 66 year old male presented with syncope and back pain and was found to be haemodynamically unstable and tender in the left upper quadrant. There was no preceding trauma. He has a background of extensive major arterial reconstruction and was taking apixaban for atrial fibrillation. A diagnosis of splenic rupture was confirmed on cross sectional imaging. A laparotomy and splenectomy was necessitated as salvage therapy following splenic artery embolisation. He recovered well and was discharged home 6 days after laparotomy. Conclusion Definitive intervention is required for the management of splenic ruptures. A high level of clinical suspicion should be maintained in patients taking direct oral anticoagulants presenting with haemodynamic instability. Open splenectomy remains the most definitive option for treatment of atraumatic rupture in anticoagulated patients.
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Affiliation(s)
- Ho-Cing Victor Yau
- Sir Charles Gairdner Hospital, General Surgery, WA, Australia; General Surgery, Level 8 Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA, 6009, Australia.
| | - Sharin Pradhan
- Sir Charles Gairdner Hospital, General Surgery - Western Australia Liver and Kidney (WALK), WA, Australia
| | - Lingjun Mou
- Sir Charles Gairdner Hospital, General Surgery - Western Australia Liver and Kidney (WALK), WA, Australia
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8
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Dunphy L, Abbas SH, Patel A, Tebala G. Spontaneous splenic rupture: a rare first presentation of diffuse large B cell lymphoma. BMJ Case Rep 2019; 12:12/8/e231101. [PMID: 31451478 DOI: 10.1136/bcr-2019-231101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Spontaneous splenic rupture (SSR) is a rare but potentially life-threatening entity. It can be due to neoplastic, infectious, haematological, inflammatory and metabolic causes. An iatrogenic or an idiopathic aetiology should also be considered. Depending on the degree of splenic injury and the haemodynamic status of the patient, it can be managed conservatively. A 61-year-old man presented to the emergency department with an acute abdomen, hypovolaemic shock and clotting abnormalities. However, his focused assessment with sonography for trauma showed no evidence of an aortic aneurysm, rupture or dissection. Further investigation with a CT angiogram aorta confirmed a subcapsular splenic haematoma with free fluid in the pelvis and a mass in the superior pole of the spleen. He was diagnosed with an SSR. He was initially managed non-operatively. However, his repeat CT showed an enlarging haematoma and he underwent embolisation of his splenic artery. Ultrasound-guided core biopsy of his splenic mass confirmed the diagnosis of diffuse large B-cell lymphoma. This paper will discuss the clinical presentation, differential diagnosis and management of SSR. Furthermore, it provides an important clinical lesson to maintain a high index of clinical suspicion for splenic injury in patients presenting with left upper quadrant abdominal pain radiating to the shoulder. This case also reinforces the importance of close observation and monitoring of those individuals treated conservatively for signs of clinical deterioration.
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Affiliation(s)
- Louise Dunphy
- Department of Surgery, Wexham Park Hospital, Slough, UK
| | | | - Arjun Patel
- Department of Surgery, Wexham Park Hospital, Slough, UK
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9
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Perrone L, Gervaso L, Bosco E, Serra F, Quaquarini E. Non-traumatic splenic rupture in amyloidosis as a rare evolution of multiple myeloma. Clin Pract 2019; 9:1146. [PMID: 31183027 PMCID: PMC6536836 DOI: 10.4081/cp.2019.1146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/17/2019] [Indexed: 11/23/2022] Open
Abstract
We report the case of a 64-year-old man with a diagnosis of IgG lambda multiple myeloma (MM) symptomatic for bone lesions for which he received autologous stem cell transplant after induction treatment and high-dose melphalan, thalidomide and lenalidomide therapy. Twelve years after the diagnosis, he had an unexpected and acute onset of abdominal pain with signs of hypovolemic shock. A computed tomography scan was immediately performed and demonstrated a splenic rupture. A splenectomy was performed but, a week after, the patient developed an acute respiratory distress syndrome and died. After histological exam of the spleen, non-traumatic spleen rupture due to amyloidosis was our final diagnosis. This event is potentially fatal and rare in patients with MM; clinicians should be aware of this potential course of the disease and monitor patients also for amyloid induced organ damages.
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Affiliation(s)
- Lorenzo Perrone
- Department of Oncology, Maugeri Clinical and Scientific Institutes (IRCCS), Pavia.,Department of Internal Medicine, University of Pavia
| | - Lorenzo Gervaso
- Department of Oncology, Maugeri Clinical and Scientific Institutes (IRCCS), Pavia.,Department of Internal Medicine, University of Pavia
| | - Eugenia Bosco
- Department of Oncology, Maugeri Clinical and Scientific Institutes (IRCCS), Pavia.,Department of Internal Medicine, University of Pavia
| | - Francesco Serra
- Department of Oncology, Maugeri Clinical and Scientific Institutes (IRCCS), Pavia.,Department of Internal Medicine, University of Pavia
| | - Erica Quaquarini
- Department of Oncology, Maugeri Clinical and Scientific Institutes (IRCCS), Pavia.,PhD Program in Experimental Medicine, University of Pavia, Italy
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10
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Basnet S, Mohanty E, Mir I, Dhital R, Koirala A, Tachamo N. Atraumatic splenic rupture associated with apixaban. SAGE Open Med Case Rep 2019; 7:2050313X19832490. [PMID: 30815265 PMCID: PMC6385321 DOI: 10.1177/2050313x19832490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 01/30/2019] [Indexed: 11/20/2022] Open
Abstract
Apixaban is a direct oral anticoagulant that works by inhibiting factor Xa. It has been associated with adverse bleeding outcomes including atraumatic splenic rupture. We present the case of an 86-year-old man who presented with features of left upper abdominal pain and hemorrhagic shock found to have atraumatic splenic rupture and hemoperitoneum on imaging.
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Affiliation(s)
- Sijan Basnet
- Sijan Basnet, Department of Medicine, Reading Hospital and Medical Center, West Reading, PA 19611, USA.
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11
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Radwan I, Magdy Khattab M, Mahmoud AR, Nghia TLB, Y MN, Trung DT, Hirayama K, Huy NT. Systematic review of spontaneous splenic rupture in dengue-infected patients. Rev Med Virol 2019; 29:e2029. [PMID: 30609179 DOI: 10.1002/rmv.2029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/14/2018] [Accepted: 11/16/2018] [Indexed: 11/06/2022]
Abstract
Dengue infection varies from a mild febrile form to more severe disease with plasma leakage, shock, and multiorgan failure. Several serious complications such as cardiomyopathy, encephalopathy, encephalitis, hepatic damage, and neural manifestations cause organ damage in dengue infection. Splenic rupture, a less well known but life-threatening complication, can occur in dengue. The mechanism of splenic rupture in dengue is still unclear. Optimal therapeutic management is required to save the lives of patients with this complication. The objective of this study was to conduct a systematic review of studies documenting the development of spontaneous nontraumatic splenic rupture in patients with dengue infection. In March 2018, a search was conducted systematically in nine electronic databases, in addition to hand- searching. A total of 127 references were exported to Endnote; 47 references remained after removing duplicates. Finally, 16 reports met the inclusion criteria and represented 17 cases. All articles were evaluated and data extracted according to predefined criteria: number of cases, age, sex, severity of dengue disease, days of illness before admission, methods of definitive diagnosis, timing of the event, and management and outcome. A total of 17 individual patients including 13 males and four females were found. Most of the patients were young adults (ranging from 20 to 52 years) and diagnosed with computed tomography scan and managed with splenectomy. Four cases were fatal. Pathological splenic rupture in dengue is a rare, life-threatening condition where timely management can achieve a favorable outcome.
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Affiliation(s)
- Ibrahim Radwan
- Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Online Research Club, Nagasaki, Japan, http://www.onlineresearchclub.org
| | - Mohamed Magdy Khattab
- Online Research Club, Nagasaki, Japan, http://www.onlineresearchclub.org.,Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Abdalla Reda Mahmoud
- Online Research Club, Nagasaki, Japan, http://www.onlineresearchclub.org.,Faculty of Medicine, Minia University, Minia, Egypt
| | - Thai Le Ba Nghia
- Online Research Club, Nagasaki, Japan, http://www.onlineresearchclub.org.,Faculty of Medicine, Vo Truong Toan University, Hau Giang, Vietnam
| | - Mai Nhu Y
- Online Research Club, Nagasaki, Japan, http://www.onlineresearchclub.org.,Faculty of Medicine, Vo Truong Toan University, Hau Giang, Vietnam
| | - Dinh The Trung
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Nagasaki, Japan
| | - Nguyen Tien Huy
- Evidence Based Medicine Research Group, Ton Duc Thang University, Ho Chi Minh City, Vietnam.,Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam.,Department of Clinical Product Development, Institute of Tropical Medicine (NEKKEN), School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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12
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Reinhold GW, Melonakos TK, Lyman DT. A Near Fatal Sneeze Spontaneous Splenic Rupture: A Case Report and Review of the Literature. Clin Pract Cases Emerg Med 2018; 1:190-193. [PMID: 29849293 PMCID: PMC5965167 DOI: 10.5811/cpcem.2017.2.32847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 12/08/2016] [Accepted: 02/22/2017] [Indexed: 11/11/2022] Open
Abstract
A 79-year-old female called 911 for abdominal pain in her left upper quadrant with radiation through to her back and left shoulder for three hours. Upon arrival to the emergency department her physical exam was positive only for tenderness in the left upper quadrant of her abdomen. The patient denied any history of trauma but reported she “did sneeze three times” just prior to the onset of her pain. Computed tomography angiography of the abdomen and pelvis was obtained to evaluate for vascular pathology. The radiologist immediately called with concern for splenic laceration. The general surgeon took the patient directly to the operating room where she underwent a splenectomy and recovered without sequelae. This is the first case report of spontaneous splenic rupture that resulted after the act of sneezing. It is important to be aware of this rare clinical entity because early recognition can be life saving.
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Affiliation(s)
- Gregory W Reinhold
- Promedica Monroe Regional Hospital, Department of Emergency Medicine, Monroe, Michigan
| | - Tina K Melonakos
- Promedica Monroe Regional Hospital, Department of Pharmacy, Monroe, Michigan
| | - Daniel T Lyman
- Promedica Monroe Regional Hospital, Department of Emergency Medicine, Monroe, Michigan
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13
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Abstract
A patient walked into the accident and emergency department with spontaneous onset of left-sided abdominal pain. Physical examination suggested the presence of an acute abdominal condition. He was admitted to the surgical ward with a provisional diagnosis of perforated peptic ulcer. Emergency laparotomy revealed haemoperitoneum caused by rupture of the spleen. Pathologic examination confirmed the rare diagnosis of splenic peliosis. Emergency physicians should be aware of the possibility of atraumatic splenic rupture as a cause of spontaneous haemoperitoneum, bearing in mind that isolated splenic peliosis (also known as peliosis lienis) is one of the causes of pathologic splenic rupture.
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14
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Kaufman N, Ferraro D. Splenic rupture following synchronised direct current cardioversion. BMJ Case Rep 2017; 2017:bcr-2017-221288. [PMID: 28790101 DOI: 10.1136/bcr-2017-221288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Atraumatic rupture of the normal spleen is a rare entity. Often, a triggering factor or minor physical event can be ascribed as the aetiology for rupture, including coughing, vomiting or minor medical procedures not involving the spleen. A 65-year-old man who was hospitalised for eosinophilic pneumonia developed haemodynamically unstable atrial flutter that necessitated urgent synchronised direct current cardioversion (DCCV). Two hours after successful cardioversion, he developed signs of an acute abdomen with free intraperitoneal fluid identified on bedside ultrasonography. Exploratory laparotomy revealed gross haemoperitoneum and splenic rupture requiring splenectomy. With exception of capsular defects and haemorrhage suggestive of organ rupture, the gross and histological examination of the spleen was otherwise unremarkable. The patient denied recent trauma. The cause of his spleen rupture was attributed to cardioversion and subsequent abdominal muscle contraction. This represents the first known case of splenic rupture associated with DCCV.
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Affiliation(s)
- Nicholas Kaufman
- Department of Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - David Ferraro
- Department of Pulmonary & Critical Care, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
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15
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Ananthavarathan P, Patel K, Doran C, Suggett N. Acute appendiceal abscess and atraumatic splenic rupture: A case of dual pathology. Int J Surg Case Rep 2016; 28:18-21. [PMID: 27662216 PMCID: PMC5035349 DOI: 10.1016/j.ijscr.2016.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/20/2016] [Accepted: 04/08/2016] [Indexed: 12/02/2022] Open
Abstract
Acute appendicitis may co-present with atraumatic splenic rupture. Hypovolaemic shock secondary to splenic rupture may co-exist with septic shock. Complex presentations warrant careful consideration and swift management of dual pathologies.
Introduction Atraumatic splenic rupture is a rare surgical emergency that is often attributed to neoplastic or infectious causes. Rarely, it has been identified to also occur in the setting of an acute severe sepsis and in cases of pelvic or splenic abscess formation post-appendicectomy. However, to our knowledge, the co-presentation of acute appendiceal abscess and splenic rupture has not been previously described. Presentation of case We present the case of a 67-year old male with decompensating haemorrhagic shock secondary to atraumatic splenic rupture on a background of an inadequately treated complicated appendicitis originally managed as diverticulitis with antibiotics in the community. Intra-operatively, in addition to a de-gloved, ruptured spleen; an acutely inflamed appendiceal abscess was also identified. A concomitant splenectomy, washout and appendicectomy and was therefore performed. Histopathological examination revealed a normal spleen with a stripped capsular layer. Mucosal ulceration, transmural inflammation and serositis of the appendix appeared to be consistent with acute appendicitis. Discussion Our case demonstrates how inadequately treated sepsis may predispose to an acute presentation of splenic rupture with associated haemorrhagic shock; which may initially be interpreted as septic shock. However, we demonstrate how insults such as sepsis and haemorrhagic shock may co-exist warranting careful consideration of possible dual pathologies in complex presentations which may be life-threatening. Conclusion While the causal relationship between acute appendicitis and atraumatic spontaneous splenic rupture remains unclear, our case considers and highlights the importance of considering dual pathology in patients presenting in the acute setting.
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Affiliation(s)
- Piriyankan Ananthavarathan
- Department of Colorectal Surgery, New Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, United Kingdom
| | - Kamlesh Patel
- Department of Colorectal Surgery, New Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, United Kingdom.
| | - Catherine Doran
- Department of Colorectal Surgery, New Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, United Kingdom
| | - Nigel Suggett
- Department of Colorectal Surgery, New Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham B15 2GW, United Kingdom
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16
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Thapar PM, Philip R, Masurkar VG, Khadse PL, Randive NU. Laparoscopic splenectomy for spontaneous rupture of the spleen. J Minim Access Surg 2016; 12:75-8. [PMID: 26917926 PMCID: PMC4746982 DOI: 10.4103/0972-9941.158950] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Laparoscopic splenectomy is a gold standard for management of planned benign splenic pathologies. Spontaneous rupture of the spleen (SRS) leading to acute abdomen occurs in only 1% of all splenic ruptures. Laparoscopic splenectomy in traumatic and atraumatic rupture due to intra-splenic pathology is reported. We present the first reported case of laparoscopic splenectomy in a 23-year-old male who presented with hemoperitoneum due to idiopathic or SRS. The procedure was safely accomplished with slight modified technique and minimum usage of advanced gadgets.
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Affiliation(s)
- Pinky M Thapar
- Department of Minimal Invasive Surgery, Pathology, Jupiter Hospital, Thane, Maharashtra, India
| | - Roji Philip
- Department of Minimal Invasive Surgery, Pathology, Jupiter Hospital, Thane, Maharashtra, India
| | - Vishwanath G Masurkar
- Department of Minimal Invasive Surgery, Pathology, Jupiter Hospital, Thane, Maharashtra, India
| | - Prashant L Khadse
- Department of Minimal Invasive Surgery, Pathology, Jupiter Hospital, Thane, Maharashtra, India
| | - Nilima U Randive
- Department of Minimal Invasive Surgery, Pathology, Jupiter Hospital, Thane, Maharashtra, India
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17
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Tiboni S, Abdulmajid U, Pooboni S, Wighton C, Eradi B, Dagash H. Spontaneous Splenic Hemorrhage in the Newborn. European J Pediatr Surg Rep 2015; 3:71-3. [PMID: 26788451 PMCID: PMC4712061 DOI: 10.1055/s-0035-1564610] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 08/18/2015] [Indexed: 11/03/2022] Open
Abstract
Spontaneous splenic hemorrhage in the newborn is a rare entity. The presentation is usually with a triad of bleeding, abdominal distension, and hemoperitoneum. Rapid diagnosis is essential as left untreated, death is inevitable. We present a case with an unusual initial presentation of a scrotal hematocele and ultrasonography suggesting an adrenal hemorrhage. At laparotomy, splenic preservation was unsuccessful, and therefore, splenectomy was performed. The child recovered well from the procedure.
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Affiliation(s)
- Sonia Tiboni
- Department of Paediatric Surgery, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Umar Abdulmajid
- Department of Paediatric Surgery, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Suneel Pooboni
- Department of Paediatric Intensive Care, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Christopher Wighton
- Department of Paediatrics, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Balgopal Eradi
- Department of Paediatric Surgery, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Haitham Dagash
- Department of Paediatric Surgery, Leicester Royal Infirmary, Leicester, United Kingdom
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Aubrey-Bassler FK, Sowers N. 613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review. BMC Emerg Med 2012; 12:11. [PMID: 22889306 PMCID: PMC3532171 DOI: 10.1186/1471-227x-12-11] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 07/28/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Rupture of the spleen in the absence of trauma or previously diagnosed disease is largely ignored in the emergency literature and is often not documented as such in journals from other fields. We have conducted a systematic review of the literature to highlight the surprisingly frequent occurrence of this phenomenon and to document the diversity of diseases that can present in this fashion. METHODS Systematic review of English and French language publications catalogued in Pubmed, Embase and CINAHL between 1950 and 2011. RESULTS We found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size) spleens in 35 cases and after minor trauma in 23 cases. Medications were implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its complications in 38 cases. The most common associated diseases were infectious (n = 143), haematologic (n = 84) and non-haematologic neoplasms (n = 48). Amyloidosis (n = 24), internal trauma such as cough or vomiting (n = 17) and rheumatologic diseases (n = 10) are less frequently reported. Colonoscopy (n = 87) was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n = 6), infarction (n = 6) and hamartomata (n = 5). Medications associated with rupture include anticoagulants (n = 21), thrombolytics (n = 13) and recombinant G-CSF (n = 10). Other causes or associations reported very infrequently include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm, cholesterol embolism, splenic granuloma, congenital diaphragmatic hernia, rib exostosis, pancreatitis, Gaucher's disease, Wilson's disease, pheochromocytoma, afibrinogenemia and ruptured ectopic pregnancy. CONCLUSIONS Emergency physicians should be attuned to the fact that rupture of the spleen can occur in the absence of major trauma or previously diagnosed splenic disease. The occurrence of such a rupture is likely to be the manifesting complaint of an underlying disease. Furthermore, colonoscopy should be more widely documented as a cause of splenic rupture.
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Affiliation(s)
- F Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland, Health Sciences Centre, St. John’s, Newfoundland and Labrador, St Johns, Canada
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, St Johns, Canada
- Discipline of Family Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, St Johns, Canada
| | - Nicholas Sowers
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
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Valle J, Lopera E, Sánchez ME, Lerma R, Ruiz JL. Spontaneous splenic rupture and Anisakis appendicitis presenting as abdominal pain: a case report. J Med Case Rep 2012; 6:114. [PMID: 22524971 PMCID: PMC3355033 DOI: 10.1186/1752-1947-6-114] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 04/23/2012] [Indexed: 11/11/2022] Open
Abstract
Introduction Anisakidosis, human infection with nematodes of the family Anisakidae, is caused most commonly by Anisakis simplex. Acquired by the consumption of raw or undercooked marine fish or squid, anisakidosis occurs where such dietary customs are practiced, including Japan, the coastal regions of Europe and the United States. Rupture of the spleen is a relatively common complication of trauma and many systemic disorders affecting the reticuloendothelial system, including infections and neoplasias. A rare subtype of rupture occurring spontaneously and arising from a normal spleen has been recognized as a distinct clinicopathologic entity. Herein we discuss the case of a woman who presented to our institution with appendicitis secondary to Anisakis and spontaneous spleen rupture. Case presentation We report the case of a 53-year-old Caucasian woman who presented with hemorrhagic shock and abdominal pain and was subsequently found to have spontaneous spleen rupture and appendicitis secondary to Anisakis simplex. She underwent open surgical resection of the splenic rupture and the appendicitis without any significant postoperative complications. Histopathologic examination revealed appendicitis secondary to Anisakis simplex and splenic rupture of undetermined etiology. Conclusions To the best of our knowledge, this report is the first of a woman with the diagnosis of spontaneous spleen rupture and appendicitis secondary to Anisakis simplex. Digestive anisakiasis may present as an acute abdomen. Emergency physicians should know and consider this diagnosis in patients with ileitis or colitis, especially if an antecedent of raw or undercooked fish ingestion is present. Spontaneous rupture of the spleen is an extremely rare event. Increased awareness of this condition will enhance early diagnosis and effective treatment. Further research is required to identify the possible risk factors associated with spontaneous rupture of the spleen.
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Affiliation(s)
- Joaquín Valle
- Department of Emergency Medicine, Hospital "Valle de los Pedroches," Calle Juan Del Rey Calero, S/N, Pozoblanco 14400, Córdoba, Spain.
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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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Case report-spontaneous splenic rupture-a rare complication of haematological malignancies. Indian J Surg Oncol 2011; 2:27-30. [PMID: 22693396 DOI: 10.1007/s13193-011-0064-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 03/21/2011] [Indexed: 10/18/2022] Open
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Rice JP, Sutter CM. Spontaneous splenic rupture in an active duty Marine upon return from Iraq: a case report. J Med Case Rep 2010; 4:353. [PMID: 21054871 PMCID: PMC2992067 DOI: 10.1186/1752-1947-4-353] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 11/05/2010] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Atraumatic splenic rupture is a rare event that has been associated with several infectious disease processes. In the active duty military population, potential exposure to these pathogens is significant. Here we discuss the case of an active duty Marine with spontaneous splenic rupture upon return from a six-month deployment in Iraq. CASE PRESENTATION A previously healthy 30-year-old Caucasian male active duty Marine presented with abdominal pain, fever and diarrhea after deployment to Iraq in support of Operation Iraqi Freedom. Based on clinical and radiographic evidence, a diagnosis of spontaneous splenic rupture was ultimately suspected. After exploratory laparotomy with confirmation of rupture, splenectomy was performed, and the patient made a full, uneventful recovery. Histopathologic examination revealed mild splenomegaly with a ruptured capsule of undetermined cause. CONCLUSION Spontaneous splenic rupture is a rare event that may lead to life-threatening hemorrhage if not diagnosed and treated quickly. Although the cause of this patient's case was unknown, atraumatic splenic rupture has been associated with a variety of infectious diseases and demonstrates some risks the active duty military population may face while on deployment. Having an awareness of these pathogens and their role in splenic rupture, clinicians caring for military personnel must be prepared to recognize and treat this potentially fatal complication.
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Affiliation(s)
- Jason P Rice
- Branch Medical Clinic, Marine Corps Air Station Miramar, 19871 Mitscher Way, San Diego, CA 92145, USA.
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23
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Renzulli P, Hostettler A, Schoepfer AM, Gloor B, Candinas D. Systematic review of atraumatic splenic rupture. Br J Surg 2009; 96:1114-21. [PMID: 19787754 DOI: 10.1002/bjs.6737] [Citation(s) in RCA: 201] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Atraumatic splenic rupture (ASR) is an ill defined clinicopathological entity. METHODS The aim was to characterize aetiological and risk factors for ASR-related mortality in order to aid disease classification and treatment. A systematic literature review (1980-2008) was undertaken and logistic regression analysis employed. RESULTS Some 632 publications reporting 845 patients were identified. The spleen was normal in 7.0 per cent (atraumatic-idiopathic rupture). One, two or three aetiological factors were found in 84.1, 8.2 and 0.7 per cent respectively (atraumatic-pathological rupture). Six major aetiological groups were defined: neoplastic (30.3 per cent), infectious (27.3 per cent), inflammatory, non-infectious (20.0 per cent), drug- and treatment-related (9.2 per cent) and mechanical (6.8 per cent) disorders, and normal spleen (6.4 per cent). Treatment comprised total splenectomy (84.1 per cent), organ-preserving surgery (1.2 per cent) or conservative measures (14.7 per cent). The ASR-related mortality rate was 12.2 per cent. Splenomegaly (P = 0.040), age above 40 years (P = 0.007) and neoplastic disorders (P = 0.008) were associated with increased ASR-related mortality on multivariable analysis. CONCLUSION The condition can be classified simply into atraumatic-idiopathic (7.0 per cent) and atraumatic-pathological (93.0 per cent) splenic rupture. Splenomegaly, advanced age and neoplastic disorders are associated with increased ASR-related mortality.
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Affiliation(s)
- P Renzulli
- Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital, and University of Berne, Berne, Switzerland.
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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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25
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Nana PN, Mbu RE, Tonye RN, Salihu HM, Ako SN, Fomulu NJ, Leke RJ. Rupture of the spleen due to domestic violence in pregnancy: a report of two cases. J OBSTET GYNAECOL 2008; 28:799-800. [PMID: 19085550 DOI: 10.1080/01443610802554443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- P N Nana
- The Central Maternity, Yaounde Central Hospital, Cameroon
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26
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Gedik E, Girgin S, Aldemir M, Keles C, Tuncer MC, Aktas A. Non-traumatic splenic rupture: Report of seven cases and review of the literature. World J Gastroenterol 2008; 14:6711-6. [PMID: 19034976 PMCID: PMC2773315 DOI: 10.3748/wjg.14.6711] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate seven patients with non-traumatic splenic rupture (NSR). NSR is an uncommon dramatic abdominal emergency that requires immediate diagnosis and prompt surgical treatment to ensure the patient’s survival.
METHODS: Within 11 years, seven cases were evaluated for patient characteristics, anamnesis and symptoms, method of diagnosis, findings of laparotomy, and etiology of NSR.
RESULTS: There were six (86%) male and one female (14%) patient, whose mean age was 36 ± 12.8 (17-56) years. We report here four cases of Plasmodium vivax malaria (cases I-IV), one case of hemodialysis (case V), one case of spontaneous splenic rupture (case VI), and one case of hairy cell leukemia (case VII). Splenectomy was performed in all patients. All of them made an uneventful recovery and were discharged in stable condition.
CONCLUSION: NSR is a rare entity that needs a high index of suspicion for diagnosis. Using ultrasonography or computer tomography, and peritoneal aspiration of fresh blood may assist in the diagnosis of NSR. Increased awareness of NSR can enhance early diagnosis and effective treatment.
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Domínguez-Fuentes B, Riquelme Montañez P, García-Gil D, Andrey Guerrero J. Abdomen agudo en un paciente de 54 años. Rev Clin Esp 2008; 208:529-30. [DOI: 10.1157/13128681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Wehbe E, Raffi S, Osborne D. Spontaneous splenic rupture precipitated by cough: a case report and a review of the literature. Scand J Gastroenterol 2008; 43:634-7. [PMID: 18415760 DOI: 10.1080/00365520701763472] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Spontaneous rupture of a normal spleen without a history of trauma is a rare clinical entity. We report on a case of atraumatic splenic rupture in a 61-year-old man who presented to the emergency department for abdominal pain and hypotension. There was no evidence of hematologic or infectious disease involving the spleen. The chronic cough described by the patient was the main trigger for the rupture. Although, spontaneous splenic rupture is rare, it is vital that physicians consider this diagnosis when evaluating patients with abdominal pain and hypotension. Failure to consider splenic rupture could be catastrophic and early diagnosis is essential for a better outcome.
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Affiliation(s)
- Edgard Wehbe
- Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, Kansas 67214, USA.
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López-Tomassetti Fernández EM, Delgado Plasencia L, Arteaga González IJ, Carrillo Pallares A, Hernández Siverio N. [Atraumatic rupture of the spleen: experience of 10 cases]. GASTROENTEROLOGIA Y HEPATOLOGIA 2008; 30:585-91. [PMID: 18028854 DOI: 10.1157/13112586] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The most common cause of splenic rupture is trauma. Less frequently the spleen ruptures due to an ongoing hematologic, infectious or tumoral disease (pathologic rupture). We present a series of 10 patients with atraumatic splenic rupture: in seven patients there was a pathologic rupture. Two of the remaining three patients with spontaneous rupture were morbidly obese; this association has not previously been reported. The present review discusses the etiology, pathogenesis and optimal treatment of this entity.
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Abstract
Rupture of the spleen is a relatively common complication of trauma and many systemic disorders affecting the reticuloendothelial system, including infections and neoplasias. A rare subtype of rupture occurring spontaneously and arising from a normal spleen was recognized as a distinct clinicopathologic entity. The pathogenesis is debated in the absence of external trauma or predisposing disease. It has been reported in association with apparently trivial insults such as vomiting. We report a case of a patient with spontaneous rupture of a normal spleen. Interestingly, it was observed after severe coughing.
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Affiliation(s)
- Nagib T Toubia
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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31
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Affiliation(s)
- M Lemon
- Department of Surgery, Royal Sussex County Hospital, Brighton, UK
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