Spontaneous splenic rupture secondary to metastatic gastric carcinoma: case report and review

Splenic rupture due to metastatic disease: a rare complication

We report a case of splenic rupture in an 83-year-old woman presenting with symptoms concerning for upper gastrointestinal malignancy. CT imaging revealed marked gastric thickening and a 33×33 mm splenic metastasis, with subsequent gastroscopy demonstrating a large lesion at the gastro-oesophageal junction. While awaiting further investigation, the patient developed acute onset left upper quadrant pain, peritonism and hypovolaemic shock. Urgent CT imaging demonstrated a ruptured spleen with extensive haemoperitoneum, necessitating emergency splenectomy.

Pathological rupture of the spleen in uncomplicated myeloma

Pathological rupture of the spleen in uncomplicated myeloma is extremely rare. We present a case of a splenic rupture which occurred in a 52 year old woman with uncomplicated multiple myeloma. The patient required an urgent splenectomy and had an uneventful recovery. Pathophysiological mechanisms leading to splenic rupture are discussed. Plasma cell leukaemias have been previously documented to present with splenic rupture. A subgroup of aggressive multiple myelomas such as in our case may have a similar tendency for splenic rupture.

Splenic rupture: a rare presentation of pancreatic carcinoma

CONTEXT

Splenic rupture secondary to solid malignancy is an infrequent complication that usually occurs late in the progression of a previously diagnosed cancer. In rare instances, splenic rupture precipitates the discovery of an unsuspected pancreatic carcinoma. We report 2 cases of adenocarcinoma of the pancreas in which the patients presented with splenic rupture.

OBJECTIVES

To review the clinicopathologic features of splenic rupture due to pancreatic carcinoma and to increase awareness of malignancy as a possible etiology for atraumatic splenic rupture.

DESIGN

We reviewed the clinical and pathologic data from 2 patients. A literature search was conducted to identify previous reports of splenic rupture associated with pancreatic cancer. We summarized the characteristics of the earlier cases and compared them with those of our patients.

RESULTS

We found only 4 previous reports of splenic rupture preceding the diagnosis of pancreatic cancer. In 3 of these cases, the pancreatic carcinoma grossly invaded the spleen at the time of resection. In contrast, malignancy was not suspected as the etiology of the rupture in our patients until histologic examination of the resected spleen revealed carcinoma.

CONCLUSION

Splenic rupture is an unusual presentation of cancer of the pancreas, and to our knowledge only 4 cases have been reported previously in the literature. Although an underlying malignancy is relatively rare, spleens resected for atraumatic rupture should be carefully examined for possible neoplastic etiologies.