An unusual diagnosis of splenic rupture

Roche, Matthew; Maloku, Fatmir; Abdel-Aziz, Tarek Ezzat

doi:10.1136/bcr-2014-204891

Cited by 8 publications

(9 citation statements)

References 13 publications

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“…14 Management of unstable patients with splenic rupture typically requires splenectomy for hemorrhage, but in hemodynamically stable patients, conservative management or angiographic embolization can be used. 15 Most reports of spontaneous splenic rupture (pathologic or idiopathic) required splenectomy, 4 consistent with our patient's hospital course. A minimally invasive approach to splenic resec- CRSLS MIS Case Reports from SLS.org tion in cases of splenic rupture is feasible: we were able to perform a hand-assisted laparoscopic splenectomy with a positive result in our patient.…”

Section: Discussionsupporting

confidence: 83%

Delayed Splenic Rupture after Robotic Partial Nephrectomy

Gogel¹,

Zaveri²,

Dickstein³

et al. 2020

CRSLS

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Introduction: Splenic rupture can be classified as traumatic, pathologic, or spontaneous. Spontaneous splenic rupture is rare, and accounts for only 1% of cases. Most cases of spontaneous splenic rupture involve a histopathologically abnormal spleen, but in rare cases, rupture of the spleen can occur in the absence of underlying disease or trauma. We present a case of delayed spontaneous splenic rupture in the postoperative setting following a partial nephrectomy.Case Description: A 54-y-old man presented with abdominal pain, dysuria, fever, and chills 1 week after a robotic left partial nephrectomy. An initial computed tomography scan showed no evidence of splenic injury, and he was admitted for suspected pyelonephritis. A computed tomography scan was obtained 4 d later for worsening pain and fever and revealed a 14-cm subcapsular hematoma of the spleen extending to the gastrohepatic ligament. He underwent an emergent angiogram and embolization of an actively bleeding splenic artery and inferior phrenic artery. A second embolization was required 2 d later to control ongoing bleeding. He then developed increased abdominal pain with nausea, vomiting, and continued leukocytosis secondary to a completely infarcted and necrotic spleen. A laparoscopic, hand-assisted splenectomy was performed successfully, and he was eventually discharged in stable condition. Conclusion:Spontaneous splenic rupture is extremely rare, particularly in the postoperative setting. It is possible that some of these cases are in fact secondary to occult trauma to the spleen during surgery. Prompt diagnosis and management, often with emergent splenectomy, is critical in these cases. Minimally invasive surgery is a feasible option for splenic resection in cases of spontaneous splenic rupture.

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Section: Discussionsupporting

confidence: 83%

Delayed Splenic Rupture after Robotic Partial Nephrectomy

Gogel¹,

Zaveri²,

Dickstein³

et al. 2020

CRSLS

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“…Also well-known are the Kehr's sign (left diaphragmatic irritation with the spread of pain in the left shoulder) and Balance's sign (tangible mass in the left upper quadrant of the abdomen. 8 Nevertheless, despite these clinical symptoms, a definite diagnosis of spleen rupture can only be made on the basis of findings from the US and CT abdomens. 9 In our case, based on the clinical picture and laboratory diagnosis, it was suspected of cardiac disease, but the definitive diagnosis was based on the CT abdomen and chest.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Spontaneous Spleen Rupture in Patients with Splenomegalia

Đeri¹,

Simatović²,

Regoda³

et al. 2018

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Spontaneous spleen rupture rarely occurs, and is primarily present in patients with splenomegaly. This is a life-threatening condition that, without adequate surgical treatment, always ends lethally. The very etiology of spontaneous atriumatic spleen rupture is not known, but it can often be associated with neoplastic diseases, liver cirrhosis, and some infectious diseases. Diagnosis is made by non-invasive methods (findings of red blood cell elements, ultrasonography, computerized tomography of abdominal CT, magnetic resonance NMR). The therapy consists of laparotomy, evacuation of the haemorrhagic content and removal of the spleen. Surgical treatment is successful, and as a postoperative complication, bleeding may occur as a result of inadequate care of the laryngeal artery and vein, and short gastric blood vessels. Here we presented a 58-year-old male patient who, due to a marked abdominal pain, low blood pressure, and low blood cell counts, was taken to hospital and successfully surgically treated at the Clinic for General and Abdominal Surgery.

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Section: Discussionmentioning

confidence: 99%

“…Less common symptoms include a palpable tender mass in the left upper quadrant of the abdomen (Balance’s sign) and referred pain in the left shoulder due to diaphragmatic irritation (Kehr’s sign) 12. Vomiting following splenic rupture is rare but may occur following pressure on the stomach from a haematoma 12. Occasionally, patients have presented with chest pain, or even in full cardiorespiratory arrest, with a preceding history of worsening abdominal pain 8.…”

Section: Discussionmentioning

confidence: 99%

Confusion and abdominal symptoms following a rugby tackle

Ioannides

Davies

Kluzek³

2017

BMJ Case Reports

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A 19-year-old man was sent to the emergency department following a pitch-side assessment for suspected concussion, unexplained upper abdominal tenderness and vomiting, following a high-impact tackle during a rugby match. A Focussed Assessment with Sonography for Trauma (FAST) scan performed in the emergency department suggested intra-abdominal free fluid, and subsequent head and abdominal CT imaging showed no intracranial lesion but confirmed a significant haemoperitoneum due to large splenic tear and bleeding. An emergency splenectomy was performed, which confirmed the rupture of an enlarged spleen with blood loss of almost 2 L into the peritoneal cavity. The patient made a full recovery following surgery. A subsequent histological examination revealed granulomatous inflammation characteristic of infectious mononucleosis. This unique case illustrates that physically fit patients with early hypovolaemic shock can present with symptoms mimicking concussion.

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An unusual diagnosis of splenic rupture

Cited by 8 publications

References 13 publications

Delayed Splenic Rupture after Robotic Partial Nephrectomy

Delayed Splenic Rupture after Robotic Partial Nephrectomy

Surgical Treatment of Spontaneous Spleen Rupture in Patients with Splenomegalia

Confusion and abdominal symptoms following a rugby tackle

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