Atraumatic splenic rupture simulating ruptured sigmoid diverticulitis

Jahadi, M. Reza; Bailey, Wallace; Crenshaw, Allen

doi:10.1007/bf02587242

Cited by 10 publications

(4 citation statements)

References 6 publications

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“…Kehr's sign (shoulder tip pain due to diaphragmatic irritation from intraperitoneal blood) is present in only 50% of cases 8. It may present with symptoms mimicking PE, ACS, aortic dissection, pneumonia, peptic ulcer disease or even ruptured diverticulitis 11 12…”

Section: Discussionmentioning

confidence: 99%

Chest pain in a young patient: an unusual complication of Epstein-Barr virus

Raman

Rathod²,

Banka

2014

BMJ Case Reports

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A 29-year-old man presented with sudden left-sided pleuritic chest pain on a background of sore throat during the preceding week. On examination he had tender cervical lymphadenopathy, he was tachycardic and had a 24 mm Hg blood pressure difference between the left and right arms. Bloods revealed deranged liver function tests and a lymphocytosis. His D-dimer was raised, hence he was treated for presumed pulmonary embolism before imaging was available. Monospot test was positive. He subsequently had both a CT pulmonary angiogram and a CT angiogram of the aorta to exclude pulmonary embolism and aortic dissection. The CT revealed splenomegaly with a large subdiaphragmatic haematoma secondary to splenic rupture. This had likely caused referred pain through diaphragmatic irritation. He was taken to theatre for urgent splenectomy. The unifying diagnosis was infectious mononucleosis complicated by spontaneous splenic rupture secondary to Epstein-Barr virus infection.

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Section: Discussionmentioning

confidence: 99%

Chest pain in a young patient: an unusual complication of Epstein-Barr virus

Raman

Rathod²,

Banka

2014

BMJ Case Reports

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Section: Discussionmentioning

confidence: 99%

“…1 The other conditions that may be mimicked are perforated peptic ulcer, 2 angina pectoris, myocardial infarction, ectopic pregnancy, acute appendicitis, and acute sigmoid diverticulitis. 1 Acute abdomen had quite aptly been described as "a trap for the unwary". 3 Despite a careful approach, there would remain some situations where clinical features would be non-specific in nature and base line investigations would fail to provide any diagnostic information.…”

Section: Discussionmentioning

confidence: 99%

Lesson learnt: don't prescribe heparin for hemoperitoneum!

Debnath

2003

Emergency Medicine Journal

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This paper describes a case of spontaneous rupture of the spleen that was misdiagnosed as pulmonary embolism. Because of a lack of history of trauma, rarity of occurrence, and confusing clinical presentations, an unwary clinician may fail to diagnose this condition in time. It may result in erroneous treatment of a condition, which is potentially curable.A 48 year old computer engineer presented to the accident and emergency department with lower chest and upper abdominal pain of 40 minutes' duration. The pain started an hour after he had eaten his supper, while sitting at home. The pain was sharp and severe in nature; there was no radiation, no associated aggravating or relieving factors. He felt tightness and discomfort around the chest. There was no significant medical history. On arrival his blood pressure was 96/46 mm of Hg; pulse rate 90/min and regular; respiratory rate 26/min. Examination of the chest confirmed good bilateral air entry without any adventitious sounds. Abdominal examination revealed moderate tenderness in epigastrium but no rebound; there was no rigidity and bowel sounds were present. Laboratory investigations revealed a haemoglobin concentration of 128 g/l, leucocyte count of 11.9×10 9 /l, platelet count of 340×10 9 /l, normal values of urea, electrolytes, amylase, and cardiac enzymes. Arterial blood gas analysis showed acute respiratory alkalosis and hypoxia. Erect chest rdiography was normal and did not show any free gas under the diaphragm. There was suspicion of slight changes in the electrocardiogram (S 1 Q 3 T 3 ) but no changes suggestive of acute myocardial infarction.He was transferred to the surgical ward in view of abdominal pain. However, the clinical features and investigations were not conclusive. A medical opinion was obtained. Pulmonary embolism was thought to be the provisional diagnosis. Therefore, in addition to supportive treatment, he was given intravenous heparin. On review six hours later, his main complaint appeared to be upper abdominal pain. He was no longer complaining of any chest symptoms. Abdominal examination revealed rigidity and rebound tenderness in the upper abdomen. It was becoming clear that the underlying disorder was intra-abdominal rather than intrathoracic.A perforated hollow viscus was thought to be the most probable diagnosis. At emergency laparotomy a large subcapsular haematoma was found near the splenic hilum, which had ruptured the splenic capsule. No peri-splenic adhesions or scarring of spleen were noted. The total blood loss was 1400 ml and he required three units of packed red cell transfusion. A splenectomy was performed. The spleen was not enlarged and found to be normal, both macroscopically and microscopically. His postoperative recovery was uneventful.

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“…A traumatic rupture of the spleen has been described in the medical literature as a clinical oddity with grave consequences, if unrecognized and untreated [1]. Clinical features of splenic rupture include pain, tenderness and muscle guarding in the left upper quadrant of the abdomen along with features of hamorrhagic shock [2]. In the absence of a history of trauma, other clinical diagnoses may be found on presentation, most commonly perforated peptic ulcer [3].…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Spleen Rupture: An Unusual Involvement of the Spleen in Systemic Lupus Erythematosus

Socorro¹,

Almeida

Carvalho³

et al. 2016

Clin Med Rev Case Rep

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non-traumatic rupture is extremely rare and has been associated as an unusual event in patients with SLE and so far, only six cases have been reported in the literature [5,[9][10][11][12][13]. Since in these cases there is no history of trauma, the diagnosis is often missed ou delayed.We report a 35-year-old woman with SLE who had spontaneous splenic rupture during the course of her illness and present a brief review of spontaneous splenic rupture in SLE.

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Atraumatic splenic rupture simulating ruptured sigmoid diverticulitis

Cited by 10 publications

References 6 publications

Chest pain in a young patient: an unusual complication of Epstein-Barr virus

Chest pain in a young patient: an unusual complication of Epstein-Barr virus

Lesson learnt: don't prescribe heparin for hemoperitoneum!

Spontaneous Spleen Rupture: An Unusual Involvement of the Spleen in Systemic Lupus Erythematosus

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