A Rare Case of Atraumatic Splenic Rupture Due to Chronic Pancreatitis

Abstract

Atraumatic splenic rupture is a rare but dangerous complication of chronic pancreatitis, vastly ignored in emergency literature. The anatomical relationship between the spleen and the tail of the pancreas contributes to the pathophysiology when an inflammatory process is in progress, although the mechanisms are not fully understood. The authors report the case of a 41-year-old male, previously undiagnosed with chronic pancreatitis, presenting with atraumatic splenic rupture. Due to worsening abdominal pain and hemodynamic instability, he underwent total splenectomy. The final diagnosis was obtained through contrast-enhanced abdominal computed tomography scans, intraoperative findings and histopathological examination of the surgical specimen, as frequently reported in previous cases. Total splenectomy is the treatment of choice, as the failure rate of the conservative approach is high. Few of these cases are described and a deeper understanding of the subject is needed. As this condition can worsen in a short time, a prompt diagnosis followed by adequate treatment can impact the morbidity and mortality associated with splenic rupture. High clinical suspicion is essential and increased knowledge about the pathophysiology and presentation of splenic complications in pancreatitis may alert emergency physicians to these fatal complications.

Akute nekrotisierende Pankreatitis mit hämorrhagischem Schock bei sekundärer Milzruptur: Ein Fallbericht und Literaturübersicht

“…Eine Literaturrecherche nach den Schlüsselwörtern „pancreatitis“, „splenic rupture“ und „splenic hematoma“ in Pubmed, MEDLINE und Google Scholar von Januar 2012 bis August 2022 ergab 21 publizierte Fallberichte, welche sich mit dem Thema beschäftigt haben 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 . Hierbei erfolgte in den meisten Fällen eine offene Laparotomie mit Splenektomie.…”