EP.FRI.1030 Splenic rupture in an obstructed colorectal cancer

Aims A case report of a splenic rupture resulting from an obstructed sigmoid cancer in a 62 year old patient. Patient presented with colorectal cancer symptoms, suddenly developed severe abdominal pain and hypotensive shock, a diagnosis of splenic rupture resulted in early surgical intervention (splenectomy, Hartman’s resection). Conclusion Atypical presentations could have adversely delayed the diagnosis of splenic rupture. Serial clinical assessments and observations, supported by serological and radiological tests is crucial in the management and can lead to early surgical intervention in an unstable patient. Prompt resuscitation and imaging facilitated an early diagnoses and surgical management. CT scan showed large volume of haemo-peritoneum with evidence of splenic rupture. Spleen histopathology was generally normal, with a potential of angiomatosis, but no metastatic disease. Emergency colorectal cancers still accounts for 20% of all colorectal cancers. Splenic rupture is a rare complication in an obstructed colorectal cancer, but under-reported. Traumatic splenic rupture accounts for approximately 75 % whilst atraumatic represents less than 12 %. Splenic rupture can occur in the presence of splenic neoplasms as either primary or secondary disease. This is caused by excessive traction on the spleno-colic ligament causing avulsion and tear of splenic capsule, heamatoma and subsequent spleen rupture. This can be considered as internal trauma to a viscus organ. Awareness of such a mechanism of splenic rupture in an obstructed sigmoid cancer can lead to an earlier diagnosis and get better outcomes, in the absence of trauma.

Varied presentation of tuberculosis adenopathy: an immunological and diagnostic contemplation

Tuberculous lymphadenitis is the most common presentation of extra pulmonary tuberculosis EPTB. Clinical and radiological presentation of disease may vary and differential diagnosis includes both benign and malignant conditions such as lymphomas and sarcoidosis. We present two case reports of tuberculous lymphadenitis with varied presentation. In case report Ⅰ, patient had undergone splenectomy due to traumatic splenic rupture had classical symptoms of tuberculosis, chest X-ray, CT thorax showed mediastinal and cervical lymphadenopathy. FNAC showed a picture of granulomatous lesion. In case report ⅠⅠ patient came with complaints of abdominal pain in hypochondriac region. CT and USG abdomen showed multiple enlarged retroperitoneal lymph nodes which led to a provisional diagnosis of lymphoma after which lymph node biopsy showed a granulomatous picture. This case report stresses the importance of early and quick diagnosis of tuberculosis in immunocompromised patients and highlights the risk of misdiagnosis of tuberculous lymphadenitis with other benign and malignant causes of lymphadenopathy and the importance of humoral mediated immunity in tuberculosis.

Splenic Rupture in a COVID-19 Patient – Case Report

Background: It is well known that Coronavirus disease 2019 (COVID-19) causes coagulation changes, requiring frequent monitoring for potential sequelae such as myocardial infarction and stroke. Non-traumatic splenic rupture is a rare and poorly understood occurrence in the clinical setting. Possible causes of nontraumatic splenic rupture include neoplasm, infection, inflammatory disease, iatrogenic and mechanical causes. Furthermore, increased intrasplenic tension, increased abdominal pressure, and thrombotic vascular occlusion are three possible mechanisms. The Case: We report a case of splenic rupture in a COVID-19 patient. Our patient was a 52 year old black man, presenting with diarrhea and moderate dyspnea, who was found to be COVID-19 positive. He had a past medical history significant for end-stage renal disease, chronic anemia, and aortic valve replacement. In an otherwise uneventful, 7-day hospital course, the patient’s stay abruptly resulted in a nontraumatic splenic rupture and demise. In this report, we have evaluated the likelihood of COVID-19 causing splenic rupture in a patient with no prior splenic disease. Conclusion: This case highlights the possibility of splenic rupture in otherwise normally recovering COVID-19 patients, particularly in the presence of comorbid conditions of renal failure and anticoagulation, with increased abdominal pressure during routine defecation. This information may assist in furthering the pathophysiology of COVID-19 and its life-threatening complications. In patients with COVID-19, non-traumatic splenic rupture should be considered as one of the differential diagnosis in patients who present with abdominal pain and early recognition of the same, owing to a high index of suspicion, can be lifesaving.

Non-Traumatic Splenic Rupture After Open Surgery for Type A Aortic Dissection: A Case Report and Literature Review

Aortic dissection is a severe condition that involves a tear in the wall of the major artery carrying blood out of the heart (aorta). This cardiac disease has a high mortality, particularly Stanford type A, which involves the first part of the aorta. Aortic dissection is characterized by urgent onset, rapid progress, and poor outcome [Nienaber 2003; Mehta 2002]. Surgery is the most effective treatment. Although there have been remarkable recent advances in the understanding and management of various aspects of these complex surgeries, many potential complications remain. Non-traumatic splenic rupture is a rare postoperative complication of type A aortic dissection, and there are only a few published reports discussing this complication. Splenic rupture is a life-threatening cause of intraperitoneal bleeding and often is associated with the preexisting pathology of the spleen in the absence of trauma [Renzulli 2009]. Its manifestation is characterized by abdominal pain, left shoulder pain, and even shock. Because of the history of aortic dissection, physicians initially may suspect arterial rupture. In our report, we aim to present the possibility of splenic rupture as a complication of aortic dissection surgery and the need for immediate surgical intervention.

Spontaneous Splenic Rupture as a Rare Initial Presentation in an Acute Lymphoblastic Leukemia Patient

A spontaneous rupture of the spleen is a rare but critical diagnosis of an acute abdomen, which may accompany unspecific symptoms mimicking acute pancreatitis, rupture of aortic aneurism, or acute coronary syndrome, delaying diagnosis and treatment. In patients that have experienced a severe spleen rupture, hypovolemic shock may cause catastrophic clinical outcomes. Therefore, early diagnosis is very important in order for physicians to declare the etiology for prevention and timely correction of the shock status. Several causes of spontaneous splenic rupture have been reported, including infection, vasculitis, pancreatitis, or hematological malignancies. Acute lymphoblastic leukemia (ALL) remains a rare but important cause of non-traumatic splenic rupture that physicians are required to assess for. Here, we describe a case presenting an acute abdomen due to spontaneous spleen rupture as the first manifestation. The purpose of this case report was to highlight the importance of considering spontaneous ruptures of the spleen as a rare but critical differential diagnosis of an acute abdomen, especially in patients with acute lymphoblastic leukemia.

Hepatic splenosis: Rare yet important – A case report and literature review

Hepatic splenosis is an uncommon condition that occurs following traumatic splenic rupture or splenectomy. The case of a 41-year-old male patient with multiple isolated liver masses indistinguishable from primary and metastatic liver tumours is reported. Following laparotomy, the liver lesions were resected and histopathology confirmed a diagnosis of hepatic splenosis. At an 18-month follow-up examination, no abnormalities in routine blood test, liver function, and liver computed tomography (CT) scanning were observed. After review of the literature, the following diagnostic criteria for hepatic splenosis are proposed: (1) a history of splenic trauma or splenectomy; (2) lesion(s) with a surrounding rim, particularly near the liver capsule identified by CT scanning; (3) findings on superparamagnetic iron oxide-enhanced magnetic resonance imaging or technetium-99m heat-damaged red cell scanning; and (4) histopathological findings (needle biopsy or surgical pathology). The following diagnostic process is also proposed: suspect diagnosis when criteria 1 and 2 are met; make diagnosis when criterion 3 is met; confirm diagnosis when criterion 4 is met. Laparotomy is recommended for either diagnosis or treatment when invasive procedures are necessary.