Characteristics of patients with spontaneous splenic rupture

Atraumatic Splenic Rupture Unveiling Mumps With an Underlying B-cell Lymphoid Hyperplasia: A Diagnostic Conundrum

Atraumatic splenic rupture (ASR) is an unfamiliar entity that is potentially life-threatening if there is a delay in the diagnosis. Due to its rarity and its non-specific presentation, it can be a challenge to diagnose early. In this report, we present a case of a 42-year-old male patient who presented to the emergency department with nonspecific abdominal pain and had no past medical history. The patient presented abdominal pain associated with nausea, vomiting, and sweating. On examination, the patient was found to be tachycardic and mildly hypotensive, with mild left upper quadrant tenderness, and a lactate of 4 mmol/L on venous blood gas analysis. He was urgently transferred to the resuscitation area, where resuscitation commenced. Further investigations revealed significant anemia. The contrast-enhanced CT of the abdomen performed revealed a 13-cm splenic hemostasis suggestive of non-traumatic splenic rupture. The patient lacked any history of blunt trauma or family history that could account for the splenic rupture. The patient was taken to the theatre by the surgical team as he remained unstable. He received four units of blood in the theatre and underwent splenectomy due to the spleen being unsalvageable. Post-operatively, the patient was admitted to the high-dependency unit (HDU) for close monitoring. Histological examination of the splenic tissue revealed B-cell lymphoid hyperplasia and negative PCR for clonality. The patient was found to be IgG-positive for mumps and was not vaccinated for MMR. Surgeons believe it is the main cause of ASR, given that little literature available establishes the same. The case highlights the importance of consideration of ASR in patients presenting with unexplained abdominal pain and hemodynamic instability, even without evidence of trauma. Early imaging and operative intervention are lifesaving. The histologic findings indicate that there may be an associated hemopoietic disorder, and this case highlights the need for clinicians to consider splenic involvement in patients with mumps who present with abdominal pain or signs of hemodynamic instability.

Spontaneous rupture of a normal spleen: A case report and a review of the literature emphasizing diagnostic and surgical challenges

INTRODUCTION

Spontaneous splenic rupture (SSR) is a rare but potentially fatal condition. It is commonly linked to underlying conditions such as infections, neoplasms, or hematologic diseases. SSR can also occur in a healthy spleen without any associated pathology, termed idiopathic splenic rupture. Symptoms range from non-specific abdominal pain to hemodynamic instability, often requiring emergency splenectomy. Early recognition using CT is crucial for improving outcomes.

CASE PRESENTATION

A 32-year-old male presented with severe abdominal pain for 24 h. Examination showed stable hemodynamics but tenderness in the left upper quadrant. CT revealed a subcapsular hematoma and moderate hemoperitoneum, leading to a diagnosis of SSR. Initially managed conservatively, the patient developed hemorrhagic shock 24 h later, with hemoglobin decreasing to 6.2 g/dL. An exploratory laparotomy confirmed a superior pole splenic fracture with significant hemoperitoneum, necessitating a total splenectomy. Postoperative recovery was uneventful, and the patient was discharged on postoperative day 6 with prophylactic vaccinations and lifelong penicillin.

DISCUSSION

SSR in a normal spleen is extremely rare and poses significant diagnostic and therapeutic challenges. The exact mechanisms are unclear, with theories including vascular anomalies, microtrauma, increased splenic pressure, and idiopathic factors. SSR symptoms are often non-specific, leading to misdiagnosis. Timely diagnosis using imaging, particularly contrast-enhanced CT, is essential. Management varies from conservative approaches to splenectomy, based on hemodynamic stability and splenic damage.

CONCLUSION

Spontaneous rupture of a normal spleen is a critical condition requiring high clinical suspicion for timely diagnosis and management. Further research is needed to understand its pathophysiology and risk factors.

Splenic Peliosis as a Rare Cause of Spontaneous Splenic Rupture: A Case Report

Atraumatic splenic rupture is a serious intraabdominal emergency that requires emergent intervention. This can be due to a number of causes. In this case report, we introduce a rare cause of atraumatic splenic rupture, which is an otherwise benign asymptomatic disease that only manifests clinically upon rupture, namely splenic peliosis. There is limited existing knowledge concerning the disease's etiology and diagnosis; however, this study presents the possible etiological explanations, associated risk factors, and possible radiologic diagnostic modalities.

Prevention of life-threatening bleeding complication from splenic venous ectasia by B-mode-, color Doppler- and contrast-enhanced ultrasound in a patient with ALL

Aim of the study

Spontaneous splenic rupture is a serious complication of pathologically altered spleen tissue, associated with a high mortality rate.

Case description

We describe a spontaneous splenic rupture in a patient with acute lymphoblastic leukemia undergoing chemotherapy. Ultrasound revealed splenomegaly, and diffuse splenic acute lymphoblastic leukemia-infiltration was suspected. In addition, only color Doppler sonography and contrast-enhanced ultrasound diagnosed splenic vascular ectasias with a venous-flow-profile. During therapy, short-term sonographic follow-up examinations were able to reveal an increase in the size of venous ectasias and the associated increased risk of spontaneous splenic rupture. Based on these sonographic findings, immediate surgical splenectomy was performed in the spontaneous splenic rupture case and the patient survived.

Conclusions

Ultrasound is an important diagnostic method in patients with newly diagnosed malignant hematological diseases to detect disease-related splenic pathologies. Short-term follow-up examinations of splenic vascular pathologies can detect size progression and a potential risk of spontaneous splenic rupture with life-threatening bleeding.

Effects of laparoscopic splenectomy on surgical site wound infection in patients with spleen rupture: A meta-analysis

A meta-analysis was performed to compare the effects of laparoscopic splenectomy (LS) and open splenectomy (OS) for splenic rupture on postoperative surgical site wound infections and postoperative complications. A comprehensive computerised search was conducted for studies comparing LS with OS for the treatment of splenic rupture in the PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang databases, with the search including studies published in any language between the creation of the databases and August 2023. Two researchers independently screened the literature and extracted the data. Literature quality was assessed using the Newcastle-Ottawa Scale, and the included data were collated and analysed using Stata 17.0 software for meta-analysis. Twenty-two studies involving 1545 patients were included. LS was superior to OS in the following aspects: reduced risk of postoperative surgical site wound infection (OR = 0.19, 95% CI: 0.11-0.34, p = 0.000), shortened hospital stay (standardised mean difference = -1.73, 95% CI: -2.05 to -1.40, p = 0.000), and reduced postoperative complication rate (OR = 0.22, 95% CI: 0.16-0.31, p = 0.000). Compared with OS, LS has a lower rate of postoperative wound infection, shorter hospital stay, and reduced rate of postoperative complications. LS is safe and effective for the treatment of splenic rupture and can be promoted clinically.

Spontaneous Splenic Rupture Unveiled: A Non-traumatic Case Associated With Infective Endocarditis

Spontaneous splenic rupture (SSR) is a rare and potentially life-threatening condition often associated with trauma. However, SSR can occur without evident trauma, presenting unique diagnostic challenges. We present a case report of a 32-year-old postpartum female who experienced sudden-onset abdominal pain and was diagnosed with SSR. Despite the absence of trauma, she exhibited hypovolemic shock, requiring rapid intervention. Diagnostic imaging, including CT scans, revealed a substantial splenic laceration, which led to an emergent splenectomy. The patient's postoperative course was complicated by infective endocarditis (IE) with aortic involvement, elucidated as the underlying cause of SSR. The patient underwent aortic valve replacement, received antibiotic therapy, and achieved a successful recovery. This case underscores the importance of early recognition, timely intervention, and collaboration among diverse medical specialties in managing SSR cases. Furthermore, it highlights the potential link between SSR and IE, emphasizing the meaning of considering infectious etiologies even in non-traumatic scenarios. Early identification of the underlying cause is crucial for effective management and positive patient outcomes in cases of SSR.

Atraumatic Spontaneous Splenic Rupture With Unknown Etiology

Splenic rupture of all causes is a potentially life-threatening event for patients. The infrequency of atraumatic splenic rupture (ASR) poses a significant diagnostic challenge due to atypical findings. ASR is commonly due to a spleen with an underlying disease process such as malignancy, infection, coagulopathies, or neoplasms. However, ASR without an identifiable cause is rare and poses further complexity. In this case, a 57-year-old woman with a history of hypertension presented to the emergency department complaining of chest pain and was found to have a splenic hematoma. She underwent splenic artery embolization due to her continued hemodynamic instability. The patient was ultimately treated with a splenectomy, as embolization was unsuccessful. Gross pathology revealed no underlying disease processes, nodules, or masses. Splenic hemorrhage due to atraumatic rupture of the spleen is rare and without known pathology. The case illustrates the need for providers to have high clinical suspicion of such a diagnosis to stabilize and surgically manage these patients. Few instances of ASR without an identifiable cause are found in medical literature, and further knowledge of the subject is needed.

[Spontaneous splenic rupture. Case report and literature review]

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.

Atraumatic Splenic Rupture: A Notable Complication of Rivaroxaban Use

Direct oral anticoagulants (DOACs) are well known to be associated with bleeding complications. However, little is known about their association with atraumatic splenic rupture, a potentially fatal condition. We present the case of a 73-year-old female with paroxysmal atrial fibrillation managed with rivaroxaban who developed a spontaneous atraumatic splenic rupture. This highlights the importance of recognizing this complication in patients without previous risk factors, such as abdominal trauma or infiltrative splenic disease, who are under anticoagulation with DOACs. There is a strong need for further research on this complication's underlying mechanism and management.

Spontaneous spleen rupture mimicking non-specific thoracic pain: A rare case in physiotherapy practice

BACKGROUND

The prevalence of Thoracic Pain (TP) is estimated to be low compared to other common musculoskeletal disorders such as nonspecific low back pain (LBP). Notably, compared to LBP, TP or referral pain to the thoracic area potentially may involve serious pathologies. Visceral referral of pain may present to the thoracic spine or anteriorly in the abdomen or chest. Rupture of the spleen in the absence of trauma or previously diagnosed disease is rare and rarely documented in emergency medicine literature. The incidence of red flags are higher in the thoracic area in comparison to the lumbar or cervical regions, but TP can also be of musculoskeletal origin and for this reason it is important to assess the origin of pain.

CASE DESCRIPTION

This case report describes the clinical history, evaluation and management of a 60-year-old complaining of upper thoracic, bilateral shoulder, and right upper quadrant abdominal pain. The patient's clinical findings from a physiotherapist's assessment led to a referral to a physician to explore a potential non-musculoskeletal origin. A splenectomy was required due to a non-traumatic rupture of the spleen. After 20 days of hospitalization from the surgery, the patient returned to all normal activities of daily living.

DISCUSSION AND CONCLUSION

The purpose of this current case report is to describe the clinical reasoning of a physiotherapist screening a patient who presented with thoracic pain due to a spontaneous rupture of the spleen, that resulted in a referral to another health practitioner.

Atraumatic splenic rupture in a patient treated with rivaroxaban: A case report and a narrative review

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.

Pathological and ATR-FTIR spectral changes of delayed splenic rupture and medical significance

Traumatic delayed splenic rupture often follows by a "latent period" without typical symptoms after injury. During this period, though there are no obvious symptoms, the injury is still present and changing. In this study, we constructed an SD rat model of delayed splenic rupture; evaluated the model by HE staining, Perl's staining, Masson trichrome staining and immunohistochemical staining; observed the pathological changes of spleen tissue in delayed splenic rupture at different times after splenic injury; we found that pathological change of injured tissues were different from non-injured, and has phases-change patterns, it can be roughly divided into three phases: 2-7 d, 10-14 d, and 18-28.We then investigated the relationship between the pathological changes and FTIR spectroscopy by chemometric methods. The main distinction of injured and non-injured tissue was the protein secondary structure of amide I, and the main distinctions of different phases of delayed splenic rupture were protein secondary structures and content of amide I and amide II.A classification model developed by SVM-DA was used to infer three phases (2-7 days, 10-12 days and 14-28 days). According to the most probable class, the accuracy of external validation is 96.7%. The results indicate that FTIR spectroscopy combined with various types of pathological staining has a potential for forensic identification and can provide theoretical support and diagnostic reference on clinical persistent injury.

Transjugular intrahepatic portosystemic shunt, local thrombaspiration, and lysis for management of fulminant portomesenteric thrombosis and atraumatic splenic rupture due to vector-vaccine-induced thrombotic thrombocytopenia: a case report

Introduction

Recombinant adenoviral vector vaccines against severe acute respiratory syndrome coronavirus 2 have been observed to be associated with vaccine-induced immune thrombotic thrombocytopenia. Though vaccine-induced immune thrombotic thrombocytopenia is a rare complication after vaccination with recombinant adenoviral vector vaccines, it can lead to severe complications. In vaccine-induced immune thrombotic thrombocytopenia, the vector vaccine induces heparin-independent production of platelet factor 4 autoantibodies, resulting in platelet activation and aggregation. Therefore, patients suffering from vaccine-induced immune thrombotic thrombocytopenia particularly present with signs of arterial or venous thrombosis, often at atypical sites, but also signs of bleeding due to disseminated intravascular coagulation and severe thrombocytopenia. We describe herein a rare case of fulminant portomesenteric thrombosis and atraumatic splenic rupture due to vaccine-induced immune thrombotic thrombocytopenia.

Case summary (main symptoms and therapeutic interventions)

This case report presents the diagnosis and treatment of a healthy 29-year-old male Caucasian patient suffering from an extended portomesenteric thrombosis associated with atraumatic splenic rupture due to vaccine-induced immune thrombotic thrombocytopenia after the first dose of an adenoviral vector vaccine against severe acute respiratory syndrome coronavirus 2 [ChAdOx1 nCoV-19 (AZD1222)]. Therapeutic management of vaccine-induced immune thrombotic thrombocytopenia initially focused on systemic anticoagulation avoiding heparin and the application of steroids and intravenous immune globulins as per the recommendations of international societies of hematology and hemostaseology. Owing to the atraumatic splenic rupture and extended portomesenteric thrombosis, successful management of this case required splenectomy with additional placement of a transjugular intrahepatic portosystemic shunt to perform local thrombaspiration, plus repeated local lysis to reconstitute hepatopetal blood flow.

Conclusion

The complexity and wide spectrum of the clinical picture in patients suffering from vaccine-induced immune thrombotic thrombocytopenia demand an early interdisciplinary diagnostic and therapeutic approach. Severe cases of portomesenteric thrombosis in vaccine-induced immune thrombotic thrombocytopenia, refractory to conservative management, may require additional placement of a transjugular intrahepatic portosystemic shunt, thrombaspiration, thrombolysis, and surgical intervention for effective management.

A Rare Case of Atraumatic Splenic Rupture Due to Chronic Pancreatitis

Atraumatic splenic rupture is a rare but dangerous complication of chronic pancreatitis, vastly ignored in emergency literature. The anatomical relationship between the spleen and the tail of the pancreas contributes to the pathophysiology when an inflammatory process is in progress, although the mechanisms are not fully understood. The authors report the case of a 41-year-old male, previously undiagnosed with chronic pancreatitis, presenting with atraumatic splenic rupture. Due to worsening abdominal pain and hemodynamic instability, he underwent total splenectomy. The final diagnosis was obtained through contrast-enhanced abdominal computed tomography scans, intraoperative findings and histopathological examination of the surgical specimen, as frequently reported in previous cases. Total splenectomy is the treatment of choice, as the failure rate of the conservative approach is high. Few of these cases are described and a deeper understanding of the subject is needed. As this condition can worsen in a short time, a prompt diagnosis followed by adequate treatment can impact the morbidity and mortality associated with splenic rupture. High clinical suspicion is essential and increased knowledge about the pathophysiology and presentation of splenic complications in pancreatitis may alert emergency physicians to these fatal complications.

Atraumatic splenic rupture and infection-related glomerulonephritis in a patient with infected aortic aneurysm: A case report

Introduction

Atraumatic splenic rupture is very rare and the case is often difficult to determine. We report a case of atraumatic splenic rupture in a patient with an infected aortic aneurysm.

Case presentation

A 40-year-old man under evaluation and treatment for renal dysfunction presented with the sudden onset of epigastric pain. The patient had a previous history of aortic arch replacement for Stanford type B aortic dissection. Contrast-enhanced computed tomography revealed intraabdominal hemorrhaging around the spleen and intrasplenic extravasation of contrast medium, and atraumatic splenic rupture was diagnosed. The patient slipped into hemorrhagic shock, and emergency splenectomy was scheduled. The histopathological diagnosis was splenic rupture with splenic infarction. The patient became febrile on postoperative day 10. Repeat contrast-enhanced computed tomography revealed enlargement of a cystic aortic aneurysm that was present prior to splenectomy. Infected aortic aneurysm was suspected, which was confirmed following thoracic endovascular aortic repair performed on postoperative day 12.

Discussion

We consider that splenic rupture occurred following infected of the kidney and spleen by an infected aortic aneurysm.

Conclusion

Infection should be considered as a cause in patients with atraumatic splenic rupture.

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Atraumatic splenic rupture was related to infection in only 27.3% of cases.

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Atraumatic splenic rupture in patients with infected aortic aneurysm is not well-documented.

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Infection-related splenic rupture should be considered in patients with acute abdominal pain.

Splenic rupture after sexual intercourse in a pregnant woman: an extremely rare case

A 33-year-old pregnant woman presented at 36 weeks gestation to the emergency with acute abdominal pain that started after vaginal intercourse. No bruising was present on the abdominal examination. An emergent cesarean delivery was performed for resistant hypotension and collapse. A fetus with cardiac arrest was delivered, and active spleen bleeding was identified at the splenocolic and gastrosplenic ligament insertion. The patient had a conservative treatment of the spleen and an uncomplicated postoperative course. The infant was resuscitated and discharged after 18 days. In conclusion, traumatic spleen rupture is an etiology to consider in pregnant women presenting with acute abdominal pain following sexual intercourse. Early suspicion and emergent cesarean delivery are the keys to optimize maternal and perinatal outcomes.

Although sexual activity is generally considered safe in pregnancy, we present a rare case of post-coital spleen rupture in a third-trimester pregnant woman. However, rupture of the spleen is an unusual but serious cause of acute abdominal pain in pregnancy and is associated with both maternal and fetal morbidity. The aim of this article is to highlight the role of early suspicion to optimize maternal and perinatal outcomes.

COVID-19 With an Initial Presentation of Intraperitoneal Hemorrhage Secondary to Spontaneous Splenic Rupture

The WHO declared coronavirus disease 2019 (COVID-19) a global pandemic in early 2020. As the pandemic has continued to evolve over a period of several months, many cases of unusual presentations are now emerging, which pose a greater challenge for physicians in terms of quickly identifying COVID-19 patients based on initial signs and symptoms. In this report, we present one such unusual presentation in a patient with sudden intraperitoneal hemorrhage and spontaneous splenic rupture with COVID-19 as the likely etiology and contributing factor. The patient was a 75-year-old Caucasian woman who presented to the emergency department (ED) with complaints of severe left-sided abdominal pain for several days without any preceding trauma. A CT of the abdomen/pelvis revealed a large amount of fluid in the abdomen, which raised suspicion of bleeding. An exploratory laparotomy revealed splenic rupture with hemoperitoneum, and the patient subsequently underwent an emergent splenectomy. The patient's COVID-19 antigen test returned positive during the surgery and was subsequently confirmed with a polymerase chain reaction (PCR) test. COVID-19 has been found to result primarily in respiratory symptoms through its ability to invade endothelial cells via angiotensin-converting enzyme 2 affinity. It is speculated that this mechanism may cause a predisposition to micro-thromboses, which can eventually lead to manifestations such as large lymphoid organ thrombosis. Based on this case presentation and the evolving literature on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spontaneous splenic rupture is an emergent differential diagnosis that should be considered in COVID-19 patients presenting with gastrointestinal complaints such as abdominal pain and nausea.

[Spleen biopsy: "pros and cons" or better "when and when not?"]

Due to the relatively high complication rate, the necessity of a spleen biopsy is controversially discussed. In establishing its indication, the clinical background and performed diagnostics must be considered. Based on the medical history, imaging procedures and sonographic course, different clinical scenarios are conceivable. The aim of this review is to describe the indications of splenic biopsy considering various clinical scenarios.

Adolescent With Spontaneous Splenic Rupture as a Cause of Hemoperitoneum in the Emergency Department: Case Report and Literature Review

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.

Spontaneous splenic hemorrhage in a patient on apixiban

Novel oral anticoagulants (NOACs) are increasingly popular. Spontaneous splenic rupture is rare and life-threatening, especially if it is not immediately recognized. Prior work has demonstrated an association with NOAC use and spontaneous splenic rupture in unusual clinical circumstances. We present the case of spontaneous splenic hemorrhage in a largely healthy 57-year old female who was recently started on apixiban for a provoked PE. She had been discharged from an outside facility, and presented just hours after discharge to our emergency department in extremis: unconscious, pale, hypotensive, and tachycardic. Her abdomen on arrival was noted to be distended with positive fluid wave, and bedside ultrasound confirmed massive peritoneal fluid. Prompt diagnostic peritoneal aspirate confirmed hemoperitoneum, and a massive transfusion protocol was initiated. The patient's blood pressure and heart rate improved, and she was stabilized for imaging. Computed tomography demonstrated large subcapsular splenic hematoma with active extravasation at the periphery of the spleen. The patient was taken emergently to interventional radiology suite where splenic artery embolization was performed and an IVC filter was placed. She subsequently developed acute respiratory distress syndrome and persistent low urine output with hypotension despite resuscitation, and was taken to the operating room for splenectomy and abdominal washout. She improved thereafter and was discharged 12 days later. Prompt diagnosis and aggressive early resuscitation contributed to this patient's outcome.

Spontaneous splenic rupture 1 week after laparoscopic appendectomy due to acute appendicitis

Spontaneous splenic rupture is a rare entity that requires high index of suspicion for diagnosis. Usually, it occurs due to underlying pathology that could be inflammatory, neoplastic or infectious. However, there are also cases of spontaneous splenic rupture in a normal-sized spleen without obvious pathologic process. In our case, the patient suffered a spontaneous splenic rupture 1 week after laparoscopic appendectomy due to acute appendicitis. Histopathologic examination revealed a normal-sized spleen without any obvious pathology. In our patient, we did not found any explanation for a spontaneous splenic rupture, besides her primary inflammatory condition.

Spontaneous splenic rupture related to anticoagulant and antiaggregant treatment

Introduction

Trauma is the most frequent cause of splenic rupture. In contrast to traumatic rupture of the spleen, spontaneous splenic rupture (SSR) is a rare and life-threatening condition.

Aim

To present the cases of patients with SSR, who had no history of trauma, and who had been receiving anticoagulant and/or antiaggregant treatment while hospitalised for cardiac reasons.

Material and methods

The cases of 6 patients with SSR at Gastroenterological Surgery Department, Kartal Koşuyolu High Speciality and Training Hospital were retrospectively evaluated. The clinicodemographic factors and the diagnostic and therapeutic methods utilised for these patients with SSR while hospitalised were investigated as well.

Results

Five (83.3%) of the patients were male and 1 (16.6%) was female. The median age of the patients was 71 (61–73) years. Three of the patients had only been receiving antiaggregant treatment, while 2 had only been receiving anticoagulant treatment; only 1 patient had been receiving both anticoagulant and antiaggregant treatments. The decrease in haematocrit (HCT) levels ascertained on the day of SSR diagnosis and the HCT levels ascertained on the day of hospitalisation were statistically significant. All the patients received a blood transfusion. While 5 (83.33%) of the 6 patients had splenectomy, 1 (16.66%) patient received conservative treatment. Mortality was seen in 4 (66.6%) patients.

Conclusions

Spontaneous splenic rupture is a condition that should be taken into consideration in the differential diagnosis of patients hospitalised for cardiac reasons, who are receiving anticoagulant and/or antiaggregant treatment in cases of newly developed abdominal pain and low HCT levels.

Spontaneous splenic rupture: a rare first presentation of diffuse large B cell lymphoma

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.

Diagnosis and Treatment of Atraumatic Splenic Rupture: Experience of 8 Cases

Atraumatic splenic rupture (ASR) is rare but life threatening. In this study, we retrospectively described our experience on the diagnosis and treatment of 8 patients (male: 6; female: 2; mean age: 49.6) with ASR. ASR accounted for 3.2% (8/251) of the splenic ruptures. The clinical presentation of ASR was similar to traumatic splenic rupture (TSR). The sensitivity of ultrasound and contrast-enhanced computed tomography (CECT) in ASR diagnosis was 57.1% and 85.7%, respectively. According to the classification of the American Association for the Surgery of Trauma (AAST), 2 cases were classified as grade II splenic ruptures, 4 cases were classified as grade III ruptures, 1 case was classified as grade IV rupture, and 1 case was not classified. All the spleens became swollen, and hematomas were observed in 6 patients. Total splenectomy was recommended in most cases. At least 62.5% (5/8) of the patients with 7 etiological factors belonged to "atraumatic-pathological splenic rupture." Local inflammation and cancer were the most common etiological factors.

Systematic review of spontaneous splenic rupture in dengue-infected patients

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.

A Near Fatal Sneeze Spontaneous Splenic Rupture: A Case Report and Review of the Literature

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.

Spontaneous Splenic Rupture in the Early Postoperative Period to After Lobectomy

Spontaneous splenic rupture is a quite rare entity that may develop secondary to some special situations (lymphoma, post-abdominal surgey etc). In the literature, the case of a patient has been reported following thoracic surgery. In a patient who had undergone right upper lobectomy for pulmonary carcinoma, signs of acute abdomen and low levels in the hemogram were detected on the fifth postoperative day; therefore, the patient underwent further investigations. A radiological evaluation revealed splenic rupture, and the patient was operated on. A case is presented that may be fatal and requires emergency response and that has to be kept in mind, although it is extremely rare. A case of spontaneous splenic rupture has been presented that may be fatal and requires emergency response; this should be kept in mind, although it is extremely rare.

Spontaneous Splenic Haematoma in a Patient on Hemodialysis: A Case Report

Spontaneous splenic hematoma is one of the rare and life-threatening complications of chronic renal failure. The diagnosis of splenic hematoma is mostly made by imaging such as ultrasound or computed tomography. The management of spontaneous splenic hematoma is not standardized till now due to the rarity of this condition. Splenectomy is recommended in hemodynamically unstable patients with features of shock. This is a case report of spontaneous splenic hematoma in a patient with chronic renal failure. This case is reported due to the rarity with renal failure.

Splenic rupture in community acquired pneumonia: A case report

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Splenic rupture is a rare complication of community acquired pneumonia.

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Clinician vigilance is required to prevent subsequent morbidity and mortality.

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Post-operative follow-up must address the potential sequelae of asplenia.

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This research did not receive any specific funding and the authors declare no conflicting interests.

Introduction

Splenic rupture is a rare but potentially lethal complication of community acquired pneumonia.

Presentation of case

We present an unusual case of haemorrhagic shock following splenic rupture requiring emergency splenectomy in a 49 year old female with community acquired pneumonia.

Discussion

The epidemiology, aetiology, pathogenesis, clinical features, investigation, management and outcomes of atraumatic splenic rupture are discussed.

Conclusion

Atraumatic splenic rupture is a rare but potentially fatal complication of numerous disease processes including pneumonia. A high index of suspicion and a thorough and systematic approach to the deteriorating patient is required to prevent related morbidity and mortality. Post-operative follow-up must address the potential sequelae of asplenia.

Spontaneous splenic rupture associated with apixaban: a case report

BACKGROUND

Spontaneous splenic rupture associated with anticoagulant use is a rare but potentially lethal disorder. Lack of prompt recognition can be associated with poor patient outcomes. The use of novel oral anticoagulants is becoming more common and thus consideration of this disorder while evaluating a patient who presents with abdominal pain while using these agents is extremely important. This is the first reported case of spontaneous splenic rupture associated with apixaban.

CASE PRESENTATION

We describe the clinical case of an 83-year-old white man who complained of sudden severe abdominal pain 5 days into a hospital stay for acute-on-chronic congestive heart failure and exacerbation of chronic obstructive pulmonary disease. Neither he nor his wife reported any significant trauma for the past 6 months prior to his admission. His medical history included chronic atrial fibrillation treated with medications including apixaban 2.5 mg twice daily. An urgent abdominal computed tomography scan demonstrated a large splenic hematoma and evidence of intraperitoneal bleeding from which he rapidly declined, developing hypovolemic shock. An emergency splenic arteriogram displayed a patent splenic artery and an embolization was successful in stabilizing him. Due to evidence of recurrent bleeding, an exploratory laparotomy and splenectomy was subsequently performed the following day.

CONCLUSIONS

The diagnosis of spontaneous splenic rupture is important to consider in a patient using apixaban who presents with abdominal pain and associated signs of hypotension and anemia. For hemodynamically unstable patients, prompt treatment to stop significant bleeding through splenic artery embolization or splenectomy is warranted and may be lifesaving.

Atraumatic splenic rupture precipitated by splenic vein thrombosis

We present the case of a 59-year-old man with atraumatic splenic rupture because of splenic vein thrombosis who was successfully treated with splenic artery embolization.

Non-traumatic splenic rupture on dual antiplatelet therapy with aspirin and ticagrelor after stenting for acute coronary syndrome

We report a case of non-traumatic splenic rupture in a 57-year-old man on dual antiplatelet therapy (DAPT) with aspirin and ticagrelor, seven months after percutaneous coronary intervention and drug-eluting stent implantation for non-ST elevation myocardial infarction. No splenic abnormalities were found at histopathological analysis after splenectomy, and no history of recent trauma was reported. Once restarted, DAPT after splenectomy, assessment of platelet function was performed by light transmittance aggregometry, showing a profound inhibition of platelet function by adenosine diphosphate, arachidonic acid, and collagen. Taking into account the bleeding risk associated with low on-treatment platelet reactivity, and to switch the patient from ticagrelor to a less potent P2Y12 inhibitor such as clopidogrel, cytochrome P450, genetic polymorphisms accounting for clopidogrel response variability were analyzed. The polymorphisms associated with lower response (CYP2C19*2, CYP2C19*3) were absent. Therefore, ticagrelor was withdrawn, and DAPT was continued with aspirin and clopidogrel. Rupture of the spleen may occur in the absence of major trauma or previous splenic diseases, and could be a complication of antithrombotic treatments. Moreover, low on-treatment platelet reactivity during DAPT is emerging as a possible risk factor for bleeding complications, so underlining the usefulness of assessing platelet function in special conditions to ensure that the patient receives the best tailored antiplatelet therapy. <Learning objective: Non-traumatic splenic rupture is a rare event, and is more often associated with pre-existing splenic abnormalities. However, it may be also a complication of medical treatments, especially with antithrombotic drugs. Low on-treatment platelet reactivity is emerging as a possible risk factor for bleeding complications; therefore, assessing platelet function in special conditions could be useful to ensure the patient receives the best-tailored antiplatelet therapy.>.