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.

P-O12 Atraumatic Splenic Rupture Secondary to Concurrent Cytomegalovirus and Epstein Barr Virus Infection

Background Infectious Mononucleosis (IM) is a common viral illness among adolescents and young adults. While most cases are self-limiting, a small number of patient can develop life threatening complications, such as atraumatic splenic rupture (ASR). This is a rare but serious sequelae, and the commonest cause of associated mortality. While Epstein Barr Virus is commonly associated with IM, concurrent infection of cytomegalovirus (CMV) and EBV is rarely reported. Both infections are associated with splenomegaly, however this is usually mild and very rarely results in ASR. Methods We present the case of an immunocompetent nineteen year old male who underwent emergency splenectomy for ASR secondary to concurrent EBV and CMV infection. He presented to the Emergency Department with a five hour history of severe, sudden onset left upper quadrant pain preceded by coughing fit. He reported a one year history of incidental splenomegaly and recent positive monospot test in community. Computerised tomography (CT) of abdomen and pelvis confirmed splenic rupture with large haemo-peritoneum and large sub-capsular haematoma. He was haemodynamically unstable and underwent laparotomy and splenectomy. Results Intraoperative findings included two litres of intraperitoneal blood and large spleen with sub-capsular haematoma; approximately seventeen centimetre diameter and weighed nine hundred and seventy grams. Pathology showed features of non-specific lymphoid hyperplasia. Serum virology confirmed high levels of CMV on polymerase chain reaction with low levels of EBV detected. Virology screening was incidentally repeated post discharge and at this time was consistent acute EBV infection. No alternative cause for splenic rupture or pre-existing splenomegaly has been identified. Conclusions The serology results in this case confirm acute CMV infection with most likely concurrent EBV infection. While we cannot confidently identify which virus caused splenic rupture in this case, ASR is a life threatening condition and an important differential in patients presenting with sudden onset LUQ pain and shock. Splenectomy remains the treatment of choice in haemodynamically unstable patients.

Unique case of atraumatic splenic rupture in a patient with chronic lymphocytic leukaemia with Richter’s transformation

Though rare, atraumatic rupture of the spleen can be a complication in certain leukaemias and lymphomas. We present a unique case of atraumatic rupture of the spleen in a patient with chronic lymphocytic leukaemia. The patient presented to the emergency department with abdominal pain; he had been on ibrutinib therapy but stopped taking the medication abruptly 6 days prior. On evaluation, he was found to have a ruptured spleen with a haemoperitoneum. Pathology of the excised spleen showed infiltration of the spleen with hyperproliferated CD5+ intermediate-to-large cells, consistent with B-cell lymphoma and favouring Richter’s transformation. There are only a few available reports of patients with similar presentations identified in our literature review.

Atraumatic Splenic Rupture Associated with Influenza A (H1N1) Pneumonia: Case Report and Review of the Literature

Influenza virus infection may present with fever, chills, headache, myalgia, malaise, and respiratory symptoms, with a few cases developing into pneumonia, respiratory failure, and other organ damage. Very few cases of atraumatic splenic rupture associated with influenza infection have been reported. Atraumatic splenic rupture, while rare, is associated with high mortality. Here, we report the first case of atraumatic splenic rupture associated with influenza infection in the English literature and review the prior reported literature. The patient was diagnosed with influenza A (H1N1) pneumonia and subsequently developed hemorrhagic shock requiring emergency laparotomy and removal of the ruptured spleen.

Ultra-high-risk choriocarcinoma with atraumatic splenic rupture: a rare case report

Choriocarcinoma is a malignant tumor associated with early vascular invasion and a high mortality. Ultra-high-risk choriocarcinoma, which was proposed in the International Federation of Gynecology and Obstetrics cancer report of 2018, has a higher risk of treatment failure and a worse prognosis than choriocarcinoma. We report a rare case of a 39-year-old female patient with ultra-high-risk choriocarcinoma (stage IV:20) with hemorrhage secondary to atraumatic splenic rupture as the initial sign. A satisfactory outcome was achieved through comprehensive treatment with surgery, chemotherapy, immunotherapy, and targeted therapy.

Characteristics and Surgical Outcomes of the Patients With Atraumatic Splenic Rupture

Background: Although splenic emergencies are rare in the case of the absence of trauma, late-diagnosed atraumatic splenic ruptures (ASR) may result in mortality. Methods: All consecutive adult patients who underwent emergency splenectomy due to ASR between January 01, 2015, and January 01, 2021, were reviewed.Results: 203 patients underwent splenectomy, 83 electively, 120 emergency splenectomy, and amongst them 15 for atraumatic reasons.The median age of patients with ASR was 55 years (34- 90), and 10 patients (66. 6%) were male. The most pre-existing medical diseases are heart valve replacement (n=5, 33. 3%) and diabetes mellitus (n=6, 40 %). Eight (46. 6%) patients had more than one comorbid disease. Ten patients (66. 6 %) had splenic rupture due to splenic infarction and abscess. Two patients were diagnosed with diffuse large B cell lymphoma (DLBCL) postoperative by histological assessment. Two patients were diagnosed with lung cancer with spleen metastasis. One patient had aortic and mitral valve replacement and was receiving an oral anticoagulant drug. The median length of hospital stay was 6 (2- 24) days and the intensive care unit stay was 2 (0- 20) days. Three patients (20%) died in hospital.Conclusion: Male sex, previous splenic infarctions, hematological malignancies, lung cancer spleen metastases, underlying cardiac diseases (valve replacement, endocarditis, atrial fibrillation) may increase the risk for ASR.