Association of Atraumatic Splenic Rupture and Acute Pancreatitis: Case Report with Literature Review

Abstract

Atraumatic splenic rupture is an uncommon complication of acute pancreatitis. This article presents a case of a 35-year-old patient presenting with acute pancreatitis who subsequently developed a splenic vein thrombosis and splenic rupture requiring a laparotomy and splenectomy. This rare but life-threatening complication requires prompt recognition and management in patients with pancreatitis who develop sudden hemodynamic instability.

Non-traumatic splenic rupture and pancreatic pseudocyst as a complication of pancreatitis: A case report

“…It is encapsulated and contains fluid inside the capsule [3] . The spleen is also involved in pancreatitis in different ways like the formation of the pseudocyst, parenchymal hematomas, infarction, and splenic rupture [ 4 , 5 ]. The involvement of the spleen and different splenic complications secondary to pancreatitis is due to close proximity of the tail of the pancreas with the splenic hilum [4] .…”

“…Trauma is the most common cause of splenic rupture. Although spontaneous rupture of a healthy spleen is rare, it may be found in patients with pancreatitis [ 3 , 4 ]. Splenic vein thrombosis is a complication of both acute and chronic pancreatitis with the overall incidence of pancreatitis-induced splenic vein thrombosis being 14.2% [6] .…”

“…The clinical features included nonspecific symptoms like abdominal pain, nausea, and vomiting. If there is splenic rupture, patients may present with left subcostal pain with or without radiation to the left shoulder and tachycardia [ 2 , 4 , 5 ]. Patients may present with features of hemorrhagic shock in case of excessive blood loss [5] .…”

“…However, since there is a good correlation between clinical and imaging pancreatitis score, imaging is not always necessary to evaluate the severity [7] . Furthermore, in case of suspected pancreatitis complications, a contrast-enhanced CT scan is the diagnostic modality of choice which can clearly identify the status of the pancreas, peripancreatic collection, site and size of the pseudocyst, splenic vein thrombus, splenic rupture, splenic hemorrhage, perisplenic collection, peritoneal collection or pleural effusion [ 1 , 4 ]. CT can also differentiate hemoperitoneum from ascitic fluid and can detect any active bleeding from the ruptured spleen or from other sites [1] .…”

“…It is important to manage cases of pancreatitis and pseudocyst as early as possible before the occurrence of fatal complications like a splenic rupture. Hemodynamically unstable patients are commonly managed by laparotomy and splenectomy, while hemodynamically stable patients can be managed by minimally invasive surgery [4] .…”