Document Type : Case reports
Authors
- Mohammad Ebrahim Kalantari 1
- Yeganeh Azadmanesh 2
- Ali Akbar Bagherzadeh 3
- Hormoz Hoseinpour 4
- Tooraj Zandbaf 5
1 Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Department of Emergency Medicine, Razavi Hospital, Mashhad, Iran
3 Faculty of Medicine, Islamic Azad University, Mashhad Branch, Mashhad, Iran.
4 Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
5 Assistant professor of general surgery, Faculty of Medicine, Islamic Azad University, Mashhad Branch, Mashhad, Iran
Abstract
Introduction: Atraumatic Splenic Rupture (ASR) is a rare but life-threatening clinicopathological phenomenon with limited information on patient features, occurrence, or etiology. ASR is an uncommon and lethal complication that is observed in infectious (mainly mononucleosis) and hematological diseases (mainly malignant homeopathies) in more than half of cases. Mortality is approximately around 20%, and some deaths occur before the diagnosis is confirmed, while others occur after surgery due to delayed management and poor patient status.
Case Presentation: A 48-year-old man with no history of the underlying disease presented to the Emergency Department with abdominal pain. He was admitted with leukocytosis 145x103/µl, hemoglobin 6.4 g/dl, platelets 15x103/µl, erythrocyte sedimentation rate 89 mm/h, and D-Dimer 1043 ng/FEU ml. Sputum test through PCR ruled out severe acute respiratory syndrome coronavirus 2 infections. Due to peripheral blood smear and bone marrow aspiration/biopsy, acute myeloid leukemia was diagnosed for the patient. On the third day of hospitalization, the patient's abdominal pain intensifies. Ultrasound revealed medium free fluid inside the abdomen and pelvis. The patient was transferred to the operating room to undergo an emergency laparotomy. There was a large hematoma in the spleen with a rupture in its posterior surface. Splenectomy was performed, and the histopathological study of the spleen showed leukemic involvement, capsular ruptures, and subcapsular hematomas.
Conclusion: ASR can occur for a variety of reasons, including non-traumatic or idiopathic factors. In the absence of significant trauma, emergency physicians should be aware that splenic rupture can occur. ASR is more likely to present with symptoms similar to the underlying diseases.
Keywords
- Renzulli P, Hostettler A, Schoepfer AM, Gloor B, Candinas D. Systematic review of atraumatic splenic rupture. Br J Surg. 2009;96(10):1114–21. doi: 10.1002/bjs.6737 . [PubMed: 19787754].
- Jafarian Ah, Kooshki Forooshani M, Farzad F, Mohamadian Roshan N. The relationship between fibroblastic growth factor receptor-1 (FGFR-1) gene amplification in triple negative breast carcinomas and clinicopathological prognostic factors. Iran J Pathol. 2019;14(4):299-304. doi: 10.30699/ijp.2019.96713.1952. [PubMed: 31754359].
- Kianmanesh R, Aguirre HI, Enjaume F, Valverde A, Brugière O, Vacher B, et al. Ruptures non traumatiques de la rate: Trois nouveaux cas et revue de la littérature. Ann Chir. 2003;128(5):303–9. doi: 10.1016/S0003-3944(03)00092-0.
- Nunes IM, Pedroso AI, Carvalho R, Ramos A. Chronic lymphocytic leukaemia and spontaneous rupture of spleen. BMJ Case Rep. 2018;2018:1-3. doi: 10.1136/bcr-2017-221692. [PubMed: 29507010].
- Aubrey-Bassler FK, Sowers N. 613 cases of splenic rupture without risk factors or previously diagnosed disease: A systematic review. BMC Emerg Med. 2012;12:1-14. doi: 10.1186/1471-227X-12-11 . [PubMed: 22889306].
- Odabas EN, Topcuoglu H, Aydogan T, Özer V, Karaca Y. A rare cause of abdominal pain: Spontaneous rupture of the spleen. J Surg Med. 2021;5(4):1–1. doi: 10.28982/josam.741681.
- Hajri A, Yaqine K, El Massi S, Errguibi D, Boufettal R, El Jai SR, et al. Spontaneous splenic rupture: A rare complication of acute myeloid leukemia. Report of a case. Ann Med Surg. 2021;65:1-3. doi: 10.1016/j.amsu.2021.102286 . [PubMed: 34026095].
- De Santis GC, Oliveira LC, Ramos AF, da Silva NDF, Falcão RP. Pathologic rupture of the spleen in a patient with acute myelogenous leukemia and leukostasis. Rev Bras Hematol Hemoter. 2014;36(4):290–2.
- Tessely H, Journe S, Katz R, Lemaitre J. Case report of a spontaneous splenic rupture in a patient with chronic lymphocytic leukaemia treated by arterial splenic embolization. Int J Surg Case Rep. 2021;80:1–4. doi: 10.1016/j.ijscr.2021.01.101 . [PubMed: 22889306].
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