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CASE REPORT
Year : 2015  |  Volume : 4  |  Issue : 3  |  Page : 199-201

Spontaneous rupture of the spleen: A case report and review of the literature


Department of General Surgery, Kurnool Medical College, Government General Hospital, Kurnool, Andhra Pradesh, India

Date of Web Publication15-Sep-2015

Correspondence Address:
Vudutha Srihari
H. No.: 46-1M-1-4, Aditya Nagar, A-Camp, Kurnool, Andhra Pradesh
India
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Source of Support: Nil., Conflict of Interest: None declared.


DOI: 10.4103/2277-8632.165407

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  Abstract 

Spontaneous rupture of the normal spleen is a rare clinical entity in the absence of trauma; the diagnosis and treatment of this fatal complication are often delayed. Regardless of the mechanism, patients typically present with upper abdominal pain, classically referred to the left shoulder, with evidence of hemoperitoneum and moderate to severe shock. Here we are presenting a rare case of spontaneous rupture of normal spleen in a young female.

Keywords: Normal spleen, splenic rupture, non traumatic, idiopathic


How to cite this article:
Srihari V, Jayaram J, Baleswari G, Sabira S, Kumar M N, Mallikarjuna N. Spontaneous rupture of the spleen: A case report and review of the literature. J NTR Univ Health Sci 2015;4:199-201

How to cite this URL:
Srihari V, Jayaram J, Baleswari G, Sabira S, Kumar M N, Mallikarjuna N. Spontaneous rupture of the spleen: A case report and review of the literature. J NTR Univ Health Sci [serial online] 2015 [cited 2020 Mar 28];4:199-201. Available from: http://www.jdrntruhs.org/text.asp?2015/4/3/199/165407


  Introduction Top


Splenic rupture is one of the many causes of the acute abdomen and in most cases of traumatic origin. Nontraumatic causes include diseases such as infection, neoplasia and infiltrative process. The diagnosis is often missed due to the absence of any history of trauma. Various aspects of atraumatic rupture of the spleen including those of pathologic and spontaneous rupture have been reviewed. Atraumatic rapture of a normal spleen is a very rare.


  Case Report Top


A 25-year-old woman was admitted to our emergency department. She complained of left upper abdominal pain and left shoulder pain, nausea, and vomiting. The pain was constant and dull. The pain started 1-day prior to admission. Her bowel and bladder habits are normal. There was no history of recent trauma.

On examination, patient was afebrile and pulse rate of 92/min with a blood pressure of 90/60 mm of Hg. She had tenderness in the left upper quadrant of her abdomen. Bowel sounds are absent. Per rectal and per vaginal examination were normal. Laboratory evaluation showed hemoglobin 9 g/dL and the platelet count was 2.70 lakhs/cumm. Abdominal plain film demonstrated no significant bowel gas pattern, but abdominal sonography showed a breach in the anterior part of the splenic capsule with perisplenic fluid, and a moderate amount of free fluid was noted in the peritoneal cavity. Contrast-enhanced computed tomography (CECT) abdomen was done, which revealed splenic capsular breach with perisplenic collection and moderate hemoperitoneum [Figure 1] and [Figure 2]. Abdominal paracentesis was done, and frank blood was aspirated from the peritoneal cavity. In view of surgical emergency, though patient is hemodynamically unstable, we proceeded for laparotomy, which revealed a huge hematoma containing splenic tissue with multiple small splenic contusions with capsular breach [Figure 3] and [Figure 4]. Other viscera including uterus and adnexa found to be normal. We proceeded for splenectomy and hemostasis secured. Gross specimen shows capsular breach, seen near the hilum and the anterior border of spleen. Histopathological findings were consistent with normal spleen [Figure 5] and [Figure 6].
Figure 1: Contrast-enhanced computed tomography abdomen showing splenic contusion

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Figure 2: Contrast-enhanced computed tomography abdomen showing peri splenic collection

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Figure 3: Intra operative image showing capsular breach of spleen

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Figure 4: Intra operative image showing splenic laceration

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Figure 5: HPE showing hemorrhagic areas with normal splenic architecture

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Figure 6: HPE showing hemorrhagic areas with normal splenic architecture

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  Discussion Top


Splenic rupture has been reported to be due to trauma or to the spontaneous rupture of a diseased spleen. However, spontaneous rapture of a normal spleen is very rare. It has been proposed that "true spontaneous" or "idiopathic" rupture refer only to spontaneous rupture of a normal spleen, and spontaneous rupture of a diseased spleen is most appropriately termed "pathologic" or "occult" rupture.[1] "True spontaneous" splenic rupture has been described in the literature, but its validity has often been challenged. Wright and Prigot stated, "There is no such clinical entity as spontaneous rupture of the normal spleen,"[2] studies proposed five criteria necessary to make the diagnosis [Table 1]. Satisfying these criteria makes the diagnosis of "true spontaneous" splenic rupture challenging because investigators must carefully consider all potential causes. Several mechanisms have been proposed to explain atraumatic rupture in the absence of disease, primarily focusing on unrecognized sources of trauma or pathology [Table 2].
Table 1: Criteria for Spontaneous Splenic Rupture

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Table 2: Proposed Mechanisms to Explain Idiopathic Rupture

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Atraumatic splenic rupture of the diseased spleen has been more commonly described and is associated with various infectious, neoplastic, hematologic, metabolic, inflammatory undetermined, her clinical presentation was suggestive of an infectious process. A variety of bacterial, viral and parasitic agents have been reported to cause splenic enlargement and predispose to spontaneous rupture. Of these known pathogens, malaria in particular has been extensively studied because it is estimated to be the primary cause of spontaneous splenic rupture worldwide.[3],[4],[5],[6] The spleen is a very vascular organ and if afflicted by disease, has an increased risk of rupture after relatively trivial stress. Recognized causes include infective, hematological, malignant, metabolic, infiltrative and local disorders [Table 3].
Table 3: Some Known Pathologies Associated with Spontaneous Splenic Rupture

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  Conclusion Top


A high index of suspicion is necessary to suspect and diagnose spontaneous rupture of spleen. The diagnose should be born in mind when a patient presented with pain abdomen and on examination having guarding and rigidity and ultrasound abdomen shows Hemoperitoneum without trauma. CECT abdomen is valuable for preoperative diagnosis. Splenectomy is a gold standard for these patients.



 
  References Top

1.
Debnath D, Valerio D. Atraumatic rupture of the spleen in adults. J R Coll Surg Edinb 2002;47:437-45.  Back to cited text no. 1
    
2.
Toubia NT, Tawk MM, Potts RM, Kinasewitz GT. Cough and spontaneous rupture of a normal spleen. Chest 2005;128:1884-6.  Back to cited text no. 2
    
3.
Ozsoy MF, Oncul O, Pekkafali Z, Pahsa A, Yenen OS. Splenic complications in malaria: Report of two cases from Turkey. J Med Microbiol 2004;53:1255-8.  Back to cited text no. 3
    
4.
Yagmur Y, Kara IH, Aldemir M, Büyükbayram H, Tacyildiz IH, Keles C. Spontaneous rupture of malarial spleen: Two case reports and review of literature. Crit Care 2000;4:309-13.  Back to cited text no. 4
    
5.
Stockinger ZT. Infectious mononucleosis presenting as spontaneous splenic rupture without other symptoms. Mil Med 2003;168:722-4.  Back to cited text no. 5
    
6.
Barbut F, Leluan P, Antoniotti G, Collignon A, Sédallian A, Petit JC. Value of routine stool cultures in hospitalized patients with diarrhea. Eur J Clin Microbiol Infect Dis 1995;14:346-9.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
References
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