Atraumatic Splenic Rupture is a Rare Complication of Acute Myeloid Leukemia: A Case Report and Literature Review

Introduction: Atraumatic Splenic Rupture (ASR) is a rare but life-threatening clinicopathological phenomenon with limited information on patient features, occurrence, or etiology. 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, and platelets 15x103/µl, ESR 89mm/h, D-Dimer 1043ng/FEU ml. Sputum test (PCR) ruled out SARS-CoV-2 infection. Due to peripheral blood smear and bone marrow aspiration/biopsy, AML 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. The histopathological study of the spleen showed leukemic involvement, capsular ruptures, and subcapsular hematomas. Discussion: ASR is an uncommon and lethal complication that is seen in infectious diseases (mainly mononucleosis) and hematological diseases (mainly malignant homeopathies) in more than half of cases. Mortality is approximately around 20%. Some deaths occur before the diagnosis is confirmed, while others occur after surgery, as a result of delayed management and poor patient status. 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 disease.

A Case of a Chronic Pancreatic Pseudocyst Causing Atraumatic Splenic Rupture without Evidence of Acute Pancreatitis

Case Reports in Surgery ◽

10.1155/2016/2192943 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

P. Moori ◽

E. J. Nevins ◽

T. Wright ◽

C. Bromley ◽

Y. Rado

Keyword(s):

Abdominal Pain ◽

Chronic Pancreatitis ◽

Pancreatic Pseudocyst ◽

Splenic Rupture ◽

Rare Complication ◽

Splenic Hilum ◽

History Of ◽

Excessive Alcohol ◽

Common Understanding

Atraumatic splenic rupture is a rare complication of a pancreatic pseudocyst (PP), described in the setting of chronic pancreatitis. There is common understanding, within the literature, that an inflammatory process at the tail of the pancreas may disrupt the spleen and result in such splenic complications. The authors present a case report of a 29-year-old male with a PP, associated with chronic pancreatitis. The patient had a history of excessive alcohol intake and presented to the emergency department with a short history of abdominal pain and vomiting. He denied any significant history of trauma and serum amylase levels were normal. An admission computed tomography (CT) scan of the abdomen confirmed the presence of a PP in direct contact with the spleen. The CT also demonstrated a heterogenous hypodense area of the splenic hilum, along with perisplenic fluid. The patient was admitted for observation. His abdominal pain progressed, and he became haemodynamically unstable. An emergency ultrasound scan (USS) at this time revealed intra-abdominal haemorrhage. A subsequent CT confirmed splenic rupture, which was managed surgically with a full recovery. Few such cases are documented within the literature and more understanding of preempting such events is needed.

Atraumatic Splenic Rupture in a SARS-CoV-2 Patient: Case Report and Review of Literature

Case Reports in Surgery ◽

10.1155/2021/5553619 ◽

2021 ◽

Vol 2021 ◽

pp. 1-5

Author(s):

Marcello Agus ◽

Maria Elena Ferrara ◽

Paola Bianco ◽

Cristina Manieli ◽

Paolo Mura ◽

...

Keyword(s):

Abdominal Pain ◽

Splenic Rupture ◽

Delayed Diagnosis ◽

Caucasian Woman ◽

Threatening Condition ◽

Life Threatening ◽

Rupture Of The Spleen ◽

Delay Of Diagnosis ◽

Possible Cause

Splenic rupture in the absence of trauma or previously diagnosed disease is rare. Due to the delay of diagnosis and treatment, this is a potentially life-threatening condition. We report a case of atraumatic splenic rupture in a SARS-CoV-2 patient. This report is of particular interest as it first identifies SARS-CoV-2 infection as a possible cause of spontaneous rupture of the spleen. A 46-year-old Caucasian woman presented at the emergency department pale and sweaty, complaining of syncopal episodes, tachycardia, hypotension, diarrhea, intense abdominal pain, diffuse arthromyalgia, and fever from the day before. RT-PCR was positive for SARS-CoV-2 infection. CT scan demonstrated extensive hemoperitoneum due to rupture of the splenic capsule. The patient required an emergency open splenectomy because of an unresponsive hemorrhagic shock. At the end of the surgery, the patient was relocated to a COVID-19 dedicated facility. COVID-19 is a new disease of which all manifestations are not yet known. Inpatients affected by SARS-CoV-2 infection with abdominal pain and spontaneous splenic rupture should be considered to avoid a delayed diagnosis.

Spontaneous splenic rupture in a patient with infectious mononucleosis

BMJ Case Reports ◽

10.1136/bcr-2019-230259 ◽

2019 ◽

Vol 12 (9) ◽

pp. e230259

Author(s):

Charlotte Ruth Baker ◽

Sid Kona

Keyword(s):

Epstein Barr Virus ◽

Splenic Rupture ◽

Rare Complication ◽

Young Female ◽

Pleuritic Chest Pain ◽

Diagnostic Challenge ◽

Barr Virus ◽

Ebv Infection ◽

Epstein Barr ◽

We present a case of spontaneous, atraumatic splenic rupture secondary to Epstein-Barr virus (EBV) infection, in a young, female patient. Splenic rupture is a rare complication of EBV infection, but is associated with the highest mortality. Additionally, this case illustrates the diagnostic challenge in a patient presenting in atypical manner, with only left-sided pleuritic chest pain, and lacking any of the classical tonsillitis symptoms associated with EBV infection.

Splenic rupture as the presenting symptom in infective endocarditis: a rare and dangerous complication

BMJ Case Reports ◽

10.1136/bcr-2021-244191 ◽

2021 ◽

Vol 14 (9) ◽

pp. e244191

Author(s):

Gautam Sen ◽

Susan Lewis

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Splenic Rupture ◽

Rare Complication ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Emergency Laparotomy ◽

Mitral Valve Leaflet ◽

Risk Patients ◽

History Of

Infective endocarditis remains a dangerous condition and carries a mortality risk of approximately 20%. Splenic rupture is a rare complication of endocarditis. A 60-year-old woman with a history of atrial fibrillation, mitral valve repair and severe mitral regurgitation was admitted with a fall and abdominal pain. Emergency laparotomy was performed leading to a diagnosis of splenic rupture, for which splenectomy was performed. Four months later, the patient represented with symptoms of a transient ischaemic attack. Transthoracic and transoesophageal echocardiogram confirmed a large vegetation on the anterior mitral valve leaflet. Treatment with antibiotics and re-do mitral valve surgery was performed. The cause of the initial splenic rupture was felt to have been secondary to undiagnosed infective endocarditis. It is imperative to consider endocarditis in a case of spontaneous splenic rupture particularly in high-risk patients such as those with previous valve surgery.

Spontaneous Splenic Rupture in Melanoma

Case Reports in Pathology ◽

10.1155/2014/865453 ◽

2014 ◽

Vol 2014 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Hadi Mirfazaelian ◽

Ahmad Oryan ◽

Aida Davari ◽

Khosrow Daneshbod ◽

Yahya Daneshbod

Keyword(s):

Abdominal Pain ◽

Malignant Melanoma ◽

Spontaneous Rupture ◽

Splenic Rupture ◽

Acute Abdominal Pain ◽

Past History ◽

Case Reports ◽

Metastatic Malignant Melanoma ◽

Free Fluid ◽

Diffuse Infiltration

Spontaneous rupture of spleen due to malignant melanoma is a rare situation, with only a few case reports in the literature. This study reports a previously healthy, 30-year-old man who came with chief complaint of acute abdominal pain to emergency room. On physical examination, abdominal tenderness and guarding were detected to be coincident with hypotension. Ultrasonography revealed mild splenomegaly with moderate free fluid in abdominopelvic cavity. Considering acute abdominal pain and hemodynamic instability, he underwent splenectomy with splenic rupture as the source of bleeding. Histologic examination showed diffuse infiltration by tumor. Immunohistochemical study (positive for S100, HMB45, and vimentin and negative for CK, CD10, CK20, CK7, CD30, LCA, EMA, and chromogranin) confirmed metastatic malignant melanoma. On further questioning, there was a past history of a nasal dark skin lesion which was removed two years ago with no pathologic examination. Spontaneous (nontraumatic) rupture of spleen is an uncommon situation and it happens very rarely due to neoplastic metastasis. Metastasis of malignant melanoma is one of the rare causes of the spontaneous rupture of spleen.

Atraumatic Splenic Rupture After Weight Lifting in a Patient Presenting With Left Shoulder Pain

Military Medicine ◽

10.1093/milmed/usaa239 ◽

2020 ◽

Vol 185 (11-12) ◽

pp. e2918-e2200

Author(s):

Megan Halliday ◽

Jared Ingersoll ◽

John Alex

Keyword(s):

Shoulder Pain ◽

Splenic Rupture ◽

Full Range ◽

Weight Lifting ◽

Free Fluid ◽

Left Shoulder ◽

First Case ◽

High Index Of Suspicion ◽

Tomography Scan

ABSTRACT We discuss a 23-year-old active duty male who presented to the emergency department with left shoulder pain after deadlifting heavy weights the day prior. His physical examination revealed a nontender and otherwise unremarkable left shoulder with full range of motion and mild tenderness to palpation in the left upper quadrant of the abdomen. A bedside focused assessment with sonography for trauma (FAST) examination showed free fluid in the abdomen and a computed tomography scan showed a splenic laceration and splenomegaly. He later tested positive for infectious mononucleosis. This is the first case report of atraumatic splenic laceration after heavy weight lifting. This case illustrates the importance of a broad differential and high index of suspicion in the patient with undifferentiated abdominal pain in order to diagnose a potentially fatal disease.

Atraumatic splenic rupture was attributed to intra-cystic haemorrhage and hypersplenism in a patient with cirrhosis and portal hypertension: A case report

SAGE Open Medical Case Reports ◽

10.1177/2050313x20901900 ◽

2020 ◽

Vol 8 ◽

pp. 2050313X2090190

Author(s):

Hao Li ◽

Dongyao Guan ◽

Junqiang Xu ◽

Enhao Jin ◽

Shu Sun

Keyword(s):

Liver Cirrhosis ◽

Portal Hypertension ◽

Splenic Rupture ◽

Liver Steatosis ◽

Sudden Onset ◽

Cystic Mass ◽

Uneventful Recovery ◽

Free Fluid ◽

Post Surgery ◽

Liver cirrhosis with splenomegaly and portal hypertension has been described in the medical literature as increasing the risk of splenic rupture. We report a case of atraumatic splenic rupture in a male with liver cirrhosis associated with splenomegaly, which was further complicated by hypersplenism and intra-cystic haemorrhage in the spleen. The 56-year-old man was hospitalized because of sudden onset of intermittent pain in the left quadrant abdomen with no history of trauma. Upon admission, the patient presented no fever, palpable abdominal tenderness, splenomegaly, and hypersplenism. Enhanced computed tomography revealed a splenic subcapsular haematoma connected to a cystic mass located at the splenic hilum and free fluid in the abdomen, which is indicative of splenic rupture. The patient underwent immediate laparotomy and splenectomy followed by proper management. Post-surgery diagnostic microscopy indicated liver steatosis, perivenular fibrosis, and regenerative nodules, which are suggestive of cirrhosis. The patient was discharged from the hospital with an uneventful recovery.

Cocaine use and splenic rupture: a rare yet serious association

Clinics and Practice ◽

10.4081/cp.2016.868 ◽

2016 ◽

Vol 6 (3) ◽

Cited By ~ 1

Author(s):

Nishrutha Karthik ◽

Karthik Gnanapandithan

Keyword(s):

Abdominal Pain ◽

Splenic Rupture ◽

Clinical Status ◽

Cardiovascular Complications ◽

Artery Embolization ◽

Splenic Artery Embolization ◽

Cocaine Use ◽

Gastroduodenal Perforation ◽

Upper Abdominal

Cocaine abuse is frequent in patients visiting the emergency department (ED). The knowledge of the cardiovascular complications of cocaine is excellent among physicians. However the awareness regarding its abdominal complications, the most important of which include gastroduodenal perforation, bowel ischemia and splenic rupture is less adequate. We report a 58-year-old with cocaine use who presents with upper abdominal pain and a rapidly worsening clinical status. He was found to have atraumatic splenic rupture causing a hemoperitoneum that was managed by intervention radiology guided splenic artery embolization. Splenic hemorrhage and rupture need timely recognition, as they are difficult to diagnose clinically and can be potentially fatal. In the encounter of patients with cocaine use who present with chest or upper abdominal pain, clinicians should consider imaging to look for splenic rupture as it is often masked or overlooked due to the complicated clinical picture.

Acute Colonoscopy-Induced Splenic Rupture Presenting to the Emergency Department

Case Reports in Emergency Medicine ◽

10.1155/2013/436874 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

Monica D. Chow ◽

Richard D. Shih

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Emergency Medicine ◽

Abdominal Pain ◽

Splenic Rupture ◽

Abdominal Ultrasound ◽

Free Fluid ◽

Abdominal Computed Tomography

Splenic rupture due to colonoscopy is a rarely reported event in the emergency medicine literature. Patients experiencing such an occurrence are likely to report to the emergency department. This paper documents an 84-year-old female who presented to the emergency department with abdominal pain and nausea less than 24 hours following a colonoscopy. An abdominal ultrasound revealed splenomegaly and free fluid. An abdominal computed tomography was significant for a splenic laceration. She underwent radiologic guided embolization and recovered without incident. Emergency medicine physicians need to consider splenic rupture as a differential in patients presenting after colonoscopy with abdominal pain.

Atraumatic splenic rupture in patient with acute pancreatitis

BMJ Case Reports ◽

10.1136/bcr-2020-238559 ◽

2021 ◽

Vol 14 (3) ◽

pp. e238559

Author(s):

Roshini Nadaraja ◽

Zarif Yahya ◽

Krinal Mori ◽

Ahmad Aly

Keyword(s):

Acute Pancreatitis ◽

High Mortality ◽

Splenic Rupture ◽

Rare Complication ◽

Mortality And Morbidity ◽

Life Threatening ◽

History Of ◽

Life Threatening Complication ◽

Atraumatic splenic rupture (ASR) is a rare complication of acute pancreatitis with high mortality and morbidity rates. We present a case of a 63-year-old woman with a history of hypertension, presenting with acute pancreatitis who subsequently developed a splenic rupture requiring a laparotomy and splenectomy. ASR is a rare but life-threatening complication requiring prompt recognition and management and should be considered in patient with pancreatitis who develops sudden haemodynamic compromise and worsening anaemia.