Non-Traumatic Spontaneous Splenic Rupture: A Rare Initial Presentation of Chronic Myeloid Leukaemia

Abstract

Chronic myeloid leukaemia (CML) is a myeloproliferative disorder, usually asymptomatic and diagnosed incidentally with an elevated WBC counts on a routine laboratory tests. Its presentation in emergency as hem peritoneum is extremely rare. Here we report a rare case of CML presented to us as spontaneous splenic rupture. A 20-year female presented with generalised abdominal pain for past 2 days with no history of trauma. On examination, patient was in shock and abdomen was distended with generalised guarding and rigidity. Ultrasound abdomen revealed enlarged liver and spleen with large fluid collection in the pelvis suspecting haemorrhage.After adequate resuscitation, patient was taken for exploratory laparotomy. Intraoperatively there was a massively enlarged spleen with bleeding actively from its superior pole. Splenectomy was done. Post operatively, patient was diagnosed as chronic myeloid leukaemia by peripheral smear and bone marrow study in view constantly elevated white blood counts. Spontaneous splenic rupture is a rare but potentially life-threatening entity. It usually occurs in pathologically enlarged spleen where rupture occurs because of infiltration of spleen by malignant cells. High index of suspicion is required to clinch the diagnosis in non-traumatic patients.