1
|
Albano GD, Zerbo S, Spanò M, Grassi N, Maresi E, Florena AM, Argo A. Delayed Traumatic Rupture of the Spleen in a Patient with Mantle Cell Non-Hodgkin Lymphoma after an In-Hospital Fall: A Fatal Case. Diagnostics (Basel) 2024; 14:1254. [PMID: 38928669 PMCID: PMC11202632 DOI: 10.3390/diagnostics14121254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/01/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Splenic rupture and hematoma are significant complications that can occur in patients with non-Hodgkin lymphoma (NHL). Understanding these associated complications is essential for optimal patient management and enhanced patient outcomes. Histopathological and immunohistochemical analyses are crucial in diagnosing NHL and assessing splenic involvement. In this study, a judicial autopsy had been requested by the Prosecutor's Office for a malpractice claim due to a fall in the hospital. In the Emergency Department, a 72-year-old man fell from a gurney and reported sustaining a wound to his forehead. No other symptoms were reported. A face and brain CT scan showed no abnormalities. Nine days after discharge, the patient presented with abdominal pain. An abdominal CT revealed splenic rupture and hemoperitoneum. The patient underwent open splenectomy but showed signs of hemodynamic shock and subsequently died. The evidence from the autopsy allowed us to diagnose mantle cell non-Hodgkin lymphoma with spleen involvement, previously unknown. Histopathological and immunohistochemical analyses were performed to assess the diagnosis of splenic rupture and estimate its timing. The findings strongly suggest that the splenic rupture was associated with the patient's fall and the pre-existing malignancy. This case highlights the importance of considering an underlying hematological malignancy when investigating delayed splenic rupture. An immunohistochemical study of spleen samples allowed the timing of splenic hematoma and rupture to be assessed, leading to the establishment of a causal relationship with trauma.
Collapse
Affiliation(s)
- Giuseppe Davide Albano
- Institute of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 129, 90100 Palermo, Italy; (S.Z.); (M.S.); (A.A.)
| | - Stefania Zerbo
- Institute of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 129, 90100 Palermo, Italy; (S.Z.); (M.S.); (A.A.)
| | - Mario Spanò
- Institute of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 129, 90100 Palermo, Italy; (S.Z.); (M.S.); (A.A.)
| | - Nello Grassi
- General Surgery Department, Department of Surgical, Oncological and Oral Sciences, University of Palermo, Via del Vespro 129, 90100 Palermo, Italy;
| | - Emiliano Maresi
- Pathological Anatomy Department, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 129, 90100 Palermo, Italy; (E.M.); (A.M.F.)
| | - Ada Maria Florena
- Pathological Anatomy Department, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 129, 90100 Palermo, Italy; (E.M.); (A.M.F.)
| | - Antonina Argo
- Institute of Legal Medicine, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Via del Vespro 129, 90100 Palermo, Italy; (S.Z.); (M.S.); (A.A.)
| |
Collapse
|
2
|
Bourgeois SL, Fey J. Facial trauma evaluation leading to a diagnosis of delayed splenic rupture. J Oral Maxillofac Surg 2014; 72:1541-4. [PMID: 24746399 DOI: 10.1016/j.joms.2014.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 02/28/2014] [Accepted: 02/28/2014] [Indexed: 10/25/2022]
Abstract
A patient presented 48 hours after falling and sustaining facial fractures and was evaluated in an outpatient setting. The patient had been seen at 2 other hospitals, including a level I trauma center, and discharged home. While undergoing evaluation for his facial trauma, the patient became severely hypotensive. The patient was diagnosed with a delayed splenic rupture and underwent splenectomy.
Collapse
Affiliation(s)
- Sidney L Bourgeois
- Chief, Oral and Maxillofacial Surgery Service; Chief, Dental Service, Syracuse Veterans Affairs Medical Center, Syracuse, NY.
| | - John Fey
- Attending Surgeon, Department of Surgery, Syracuse Veterans Affairs Medical Center, Syracuse, NY
| |
Collapse
|
3
|
Delayed splenic rupture: dating the sub-capsular hemorrhage as a useful task to evaluate causal relationships with trauma. Forensic Sci Int 2013; 234:64-71. [PMID: 24378304 DOI: 10.1016/j.forsciint.2013.10.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 10/13/2013] [Accepted: 10/28/2013] [Indexed: 11/21/2022]
Abstract
The aim of the paper was to perform a chronological assessment of the phenomenon of delayed rupture of the spleen, to assess the phenomenological order about the sub-capsular hematoma transformation to determine the causal relationship with trauma as hypothetical cause of death. 80 cases of blunt trauma with splenic capsular hematoma and subsequent rupture of the spleen were evaluated: 38 had an acute rupture of the spleen, 42 presented a break in days or weeks after the traumatic injury. Time between the traumatic event and delayed rupture of the spleen is within a range of time from one day to more than one month. Data recorded included age, sex, type of trauma, injury severity score, grade of splenic injury, associated intra-abdominal injuries, pathologic specimen evaluation. Immunohistochemical investigation of perisplenic hematoma or laceration was performed utilizing polyclonal antibodies anti-fibrinogen, CD61 and CD68, and showed structural chronological differences of sub-capsular hematoma. Expression of modification and organization of erythrocytes, fibrinogen, platelets and macrophages provides an informative picture of the progression of reparative phenomena associated with sub-capsular hematoma and subsequent delayed splenic rupture. Sub-capsular splenic hematoma dating, which we divided into 4 phases, is representing a task in both clinical practice and forensic pathology.
Collapse
|
4
|
Tian J, Xie X, Lv F, Yu T, Wu R, Zhang X, Wang D, Tang J. Evaluation and establishment of a canine model of delayed splenic rupture using contrast-enhanced ultrasound. Mol Med Rep 2012; 6:483-7. [PMID: 22710316 PMCID: PMC3493049 DOI: 10.3892/mmr.2012.948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 06/08/2012] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to establish a canine model of delayed splenic rupture (DSR). A total of 15 mongrel dogs were anesthetized and laparotomized. The hematomas were observed following an injection of heparin. The hematomas were ruptured. The severity of the spleen rupture was evaluated and the intra-abdominal free liquid was measured. The splenic hematomas in the dogs continued to form and the hematoma area gradually increased. The hematomas were ruptured after impacting the abdominal wall. The spleens were damaged, and conventional ultrasonography showed intra-abdominal free liquid. These conditions were demonstrated via computed tomography scanning. A DSR canine model was established successfully.
Collapse
Affiliation(s)
- Jiangke Tian
- Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing 100853, PR China
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Death due to hemorrhagic shock after delayed rupture of spleen: a rare phenomenon. Am J Forensic Med Pathol 2010; 30:382-3. [PMID: 19901812 DOI: 10.1097/paf.0b013e3181c03caf] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Delayed splenic rupture after blunt trauma is rare and contributes to a significant mortality rate. As this is accompanied by a period of clinical quiescence, a close clinical vigilance is required for early diagnosis and surgical intervention. A case report on death because of delayed rupture of healthy spleen after blunt trauma is presented. The pathophysiology of delayed rupture and importance of early detection are discussed. The case presented is the first known case of death due to delayed splenic rupture in Sri Lanka.
Collapse
|
6
|
Lee JS, Kwon OY, Choi HS, Hong HP, Ko YG. Delayed Splenic Rupture with a 1-month Latent Period after Minor Trauma - A Case Report -. ACTA ACUST UNITED AC 2010. [DOI: 10.4266/kjccm.2010.25.2.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jong Seok Lee
- Department of Emergency Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Oh Young Kwon
- Department of Emergency Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Han Sung Choi
- Department of Emergency Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Hoon Pyo Hong
- Department of Emergency Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Young Gwan Ko
- Department of Emergency Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| |
Collapse
|
7
|
An unusual presentation of non pathological delayed splenic rupture: a case report. CASES JOURNAL 2009; 2:6450. [PMID: 19829806 PMCID: PMC2740109 DOI: 10.4076/1757-1626-2-6450] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Accepted: 06/05/2009] [Indexed: 11/25/2022]
Abstract
The diagnosis of Delayed Splenic Rupture poses a major challenge to even the most astute clinician, as it can mimic other medical emergencies. We present a case of an unusual presentation of delayed splenic rupture in a 23-year-old Caucasian man, who presented to the emergency department with a 2 day history of left upper quadrant pain. He initially denied any history of trauma. There were no signs of generalized peritonisim on examination but his haemoglobin level was low (8.9 gm/dl) for which there was no obvious cause identified. He was resuscitated and a computed tomography of the abdomen was performed. This revealed complete rupture of the splenic capsule with haemorrhagic fluid in the abdomen. With the computed tomography abdomen findings and further questioning of the patient, the only potential precipitating event that he could remember was a minor kick to the left upper quadrant more than 2 weeks ago while playing football. An urgent splenectomy was performed and histology confirmed complete rupture of the splenic capsule with a large adherent haematoma to the capsule. This case illustrates the difficulty in diagnosing delayed splenic rupture especially when accurate history is not available. A high index of suspicion is essential as delay in diagnosis can be fatal. Early diagnosis in suspected cases can be achieved by performing computed tomography of the abdomen.
Collapse
|
8
|
Sharma OP, Oswanski MF, Singer D. Role of Repeat Computerized Tomography in Nonoperative Management of Solid Organ Trauma. Am Surg 2005. [DOI: 10.1177/000313480507100315] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nonoperative management (NOM) of blunt spleen and liver trauma is currently well accepted. CT imaging is helpful in selecting treatment options and to evaluate resolution of solid organ trauma. This 8-year study was undertaken to assess the role of repeat CT scans in NOM by analyzing indications of surgery in NOM failures. NOM was undertaken in 221 patients with spleen/liver trauma. After initial CT scans, 82 (37%) scans were repeated in 65 patients. There was failure of NOM (NOMF) in 11 patients. Follow-up imaging was done prior to delayed surgery in 4 (36%) patients, 4.9 per cent of repeat scans. Two of these patients had hemodynamic instability and, in the other two, there were clinical signs of peritonitis. The remaining seven patients had delayed surgery due to hemodynamic instability. There is a limited role of repeat CT scans in NOM of spleen and liver trauma. Repeat CT should be done more liberally in patients with suspected intestinal and mesenteric trauma, unexplained blood loss, complex hepato-biliary trauma, and in patients with neurological or pharmacological paralysis.
Collapse
Affiliation(s)
- Om P. Sharma
- Department of Trauma Services, The Toledo Hospital & Toledo Children's Hospital, Toledo, Ohio
| | - Michael F. Oswanski
- Department of Trauma Services, The Toledo Hospital & Toledo Children's Hospital, Toledo, Ohio
| | - Daniel Singer
- Department of Trauma Services, The Toledo Hospital & Toledo Children's Hospital, Toledo, Ohio
| |
Collapse
|
9
|
Allen TL, Greenlee RR, Price RR. Delayed splenic rupture presenting as unstable angina pectoris: case report and review of the literature. J Emerg Med 2002; 23:165-9. [PMID: 12359285 DOI: 10.1016/s0736-4679(02)00486-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The diagnosis of delayed rupture of the spleen can be challenging if the history of trauma is remote, or initially missed. Delayed rupture of the spleen can occur in approximately 1% of blunt force injuries to the spleen. We present a difficult case of delayed rupture of the spleen from remote, minor trauma and discuss the literature associated with this injury.
Collapse
Affiliation(s)
- Todd L Allen
- Department of Emergency Medicine, LDS Hospital, Salt Lake City, Utah 84143, USA
| | | | | |
Collapse
|
10
|
|
11
|
Abstract
Four patients with pseudocyst of the spleen gave histories of abdominal trauma. In one patient the pseudocyst had ruptured, necessitating emergency splenectomy 34 years after the original injury. In a second patient the pseudocyst was discovered incidentally, and was managed by spleen-preserving excision; and the third and fourth presented with abdominal pain and had splenectomy and spleen-preserving surgery, respectively. All patients with conservatively treated splenic injury are at risk of developing a pseudocyst of the spleen, and the lesion can be detected by computed tomography or ultrasound. When there are no symptoms the natural history is unknown; but if surgery is necessary, splenectomy can sometimes be avoided.
Collapse
Affiliation(s)
- P S Sinha
- Department of Surgery, Greenwich District Hospital, London, UK
| | | | | |
Collapse
|
12
|
Abstract
A 12-year-old boy was treated conservatively for a grade II splenic laceration. On discharge, he was instructed to avoid contact sports, running, and strenuous physical activity. Thirty-eight days later, after diving off the side of a swimming pool, he had abdominal pain, nausea, and diaphoresis. On admission, he was hemodynamically unstable. Results of a diagnostic lavage showed gross blood. At laparotomy, a fractured spleen was found, and splenectomy was performed. He recovered without complication. This case questions the activity restrictions placed on patients with conservatively managed splenic trauma. Avoidance of only contact sports and heavy exertion may be inadequate.
Collapse
Affiliation(s)
- R L Brown
- Department of Surgery, Children's Hospital of Buffalo and State University of New York at Buffalo, School of Medicine and Biomedical Sciences, 14222, USA
| | | | | | | | | |
Collapse
|
13
|
Maw A, Puntis MCA. Delayed splenic rupture complicating laparoscopic cholecystectomy - case report and review. MINIM INVASIV THER 1997. [DOI: 10.3109/13645709709152832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
14
|
Abstract
The entity of delayed splenic rupture is often challenged. This case report describes a patient who presented with splenic rupture 2 years after a prior splenic injury from blunt trauma. The pathology report confirmed previous splenic injury. Delayed splenic rupture is possible for extended periods following splenic injury managed conservatively.
Collapse
Affiliation(s)
- C M Fernandes
- Department of Emergency Medicine, St. Paul's Hospital, Vancouver, BC, Canada.
| |
Collapse
|
15
|
Abstract
The diagnosis of splenic hematoma can be clinically challenging. A case of delayed rupture of an atraumatic splenic hematoma is described, illustrating how unusual the presentation of this entity can be.
Collapse
Affiliation(s)
- C C McDonald
- Department of Emergency Services, Wake Medical Center, Raleigh, NC., USA
| |
Collapse
|
16
|
Affleck TP. Severe Sports-Related Spleen Injury. PHYSICIAN SPORTSMED 1992; 20:109-123. [PMID: 29281436 DOI: 10.1080/00913847.1992.11947486] [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: 10/18/2022]
Abstract
In brief Most minor spleen injuries can be managed conservatively, but severe splenic ruptures often require operative treatment. In this case report, however, a young football player who severely injured his spleen was able to recover nonoperatively because he was hemodynamically stable. His case highlights issues of diagnosis, injury classification, and treatment options, as well as when to return an athlete to play.
Collapse
|
17
|
Lewis FW, Moloo N, Stiegmann GV, Goff JS. Splenic injury complicating therapeutic upper gastrointestinal endoscopy and ERCP. Gastrointest Endosc 1991; 37:632-3. [PMID: 1756925 DOI: 10.1016/s0016-5107(91)70872-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- F W Lewis
- Department of Medicine, University of Colorado Health Sciences Center, Denver
| | | | | | | |
Collapse
|
18
|
Gendron BP, Gatrell CB. Spontaneous rupture of the spleen in initial presentation of Hodgkin's disease. Ann Emerg Med 1991; 20:424-5. [PMID: 2003674 DOI: 10.1016/s0196-0644(05)81668-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A 46-year-old man presented with a four-week history of fevers, occasional chills, and a two-week history of sweats and poor appetite. He also complained of progressive weakness and lethargy. After initial evaluation, while awaiting further consultation, the patient developed rapidly progressing abdominal pain and light-headedness. He was moved immediately into the emergency treatment area. He was noted to have an acute abdomen and was taken to surgery. An enlarged Hodgkin's-infiltrated spleen with an actively bleeding hematoma was removed. The patient denied any history of trauma.
Collapse
Affiliation(s)
- B P Gendron
- Department of Emergency Medicine, Madigan Army Medical Center, Tacoma, Washington 98431-5000
| | | |
Collapse
|