Atraumatic splenic rupture in a peritoneal dialysis patient

Abstract

Splenic hemorrhage is a potentially life-threatening complication usually occurring after blunt trauma to the abdomen. Atraumatic splenic rupture (ASR) is an uncommon condition, and mostly results from pathology affecting the spleen, such as tumor infiltration or infection. Here, we report a case of atraumatic rupture of a normal spleen in a patient undergoing peritoneal dialysis, and review similar cases in the literature. The case involved a 58-year-old man with nephrotic syndrome who had been undergoing peritoneal dialysis for 1 year. He presented to the hospital with abdominal pain, nausea, and blood-stained dialysate. Laboratory data revealed severe anemia, with a hemoglobin of 4.3 g/dL. An abdominal computed tomography (CT) scan demonstrated a high-density area around the spleen and malposition of the catheter. Laparoscopy revealed large amounts of coagulated blood surrounding the spleen. The patient was diagnosed with atraumatic splenic bleeding. He improved with bed rest and blood transfusion, and could continue with peritoneal dialysis. It was considered that the etiology of bleeding was directly from the spleen. However, due to the temporary malposition of the peritoneal catheter, catheter-induced splenic trauma could not be ruled out. ASR is a rare entity that needs a high index of suspicion for diagnosis. Using CT scanning and peritoneal fluid analysis, these modalities may assist in the diagnosis. Emergency intervention is required upon definitive diagnosis. Increased awareness of ASR can enhance the early diagnosis and effective treatment.

Ruptura esplênica espontânea em criança COVID-19: relato de caso / Spontaneous splenic rupture in a child with COVID-19: case report

“…Apresenta etiologia multifatorial, sendo a causa infecciosa viral já bem estabelecida. [1] O caso relatado apresenta paciente com infecção viral por SARS-COV2, que evolui com esplenomegalia, distúrbio de coagulação e necessidade de ECMO e diálise peritoneal. Cursou com ruptura esplênica e necessidade de esplenectomia.…”

Splenic abscess diagnosed following relapsing sterile peritonitis in a peritoneal dialysis patient: A case report with literature review

“…We reviewed the relevant literature on PubMed for secondary peritonitis in PD patients since 2017 (Table 1). [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] Out of the 16 cases, perforation was the most common cause of secondary peritonitis, which might be easier to diagnose due to changes in dialysate properties. Two cases were complicated with abscesses in the kidney 8 and the spleen, as shown in our case, respectively.…”

A Rare Case of Unilateral Pleural Effusion in a Pediatric Patient on Chronic Peritoneal Dialysis: Is it a Pleuroperitoneal Leakage?

“…There were some cases of atraumatic damage of the intraabdominal organ, such as spleen rupture, bowel erosion, and perforation. Retrospective studies of the serial changes of CT peritoneography in patients with symptomatic ultrafiltration failure have shown that retroperitoneal leakage, anterior abdominal wall leakage, and inguinal hernia can occur without trauma [12][13][14] . Intra-abdominal pressure in patients on PD can be changed depending on the patients' position, dialysate volume, and coughing.…”