Rare case of spontaneous splenic rupture

Arachchi, Asiri; Schoor, Leendert Van; Wang, Luke; Smith, C Daniel; Heng, L. S.

doi:10.1111/ans.13192

Cited by 6 publications

(6 citation statements)

References 3 publications

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“…13 Abdominal CT imaging is 97% sensitive and specific in the diagnosis of splenic rupture. 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.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

Delayed Splenic Rupture after Robotic Partial Nephrectomy

Gogel¹,

Zaveri²,

Dickstein³

et al. 2020

CRSLS

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“…Due to the of lack an internationally-recognised consensus regarding classification, the literature consists of sporadic case reports which attribute various causes to making the spleen vulnerable to spontaneous bleeding in the absence of trauma. Although acute EBV infection is cited as the most common cause of ASR[2], less common causes include cytomegalovirus infection[7], tuberculosis[8], meliodosis (infection with Burkholderia pseudomallei )[9], amyloidosis[10], systemic lupus erythematosus[11] and splenic vein thrombosis due to prothrombin gene mutation[12]. There are even reports of ASR being caused by an ectopic pregnancy[13] and splenic metastases of melanoma[14].…”

Section: Discussionmentioning

confidence: 99%

Atraumatic splenic rupture after cocaine use and acute Epstein-Barr virus infection: A case report and review of literature

Kwok¹

2019

WJGS

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BACKGROUNDAtraumatic splenic rupture (ASR) accounts for just over 3% of all cases of splenic rupture and is associated with a high mortality rate. The most common culprit is acute infection with Epstein-Barr virus (EBV) but other documented aetiologies include neoplasia, other viral/bacterial infections, acute and chronic pancreatitis, amyloidosis and anticoagulant medications. There are four previous reports of cocaine-associated ASR but never before has it been documented in combination with concurrent acute EBV infection.CASE SUMMARYA 21-year-old man presented to hospital with acute left shoulder pain which radiated to the right shoulder and upper abdomen. He denied any history of recent trauma and had no relevant past medical history. He took no regular prescription medications but had used cocaine within the previous 24 h. Investigations revealed splenomegaly, a Grade 3 subcapsular splenic haematoma, moderate haemoperitoneum and an incidental 9 mm splenic artery pseudoaneurysm. There was also serological evidence of acute EBV infection. Prophylactic endovascular embolisation of the pseudoaneurysm was performed and the splenic rupture was managed non-operatively. The patient remained admitted in hospital for seven days and did not require any transfusion of blood products. Serial imaging showed complete resolution of the haemoperitoneum after 5 wk. The importance of abstinence from illicit drug use was emphasised to the patient but it is unknown whether or not he remains compliant.CONCLUSIONThis case demonstrates that ASR is a rare condition that can result from acute EBV infection and cocaine ingestion and requires a high index of suspicion to diagnose clinically.

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“…It is derived from vascular tissues and accounts for only 2% to 4% of all soft tissue sarcomas. [ 5 – 9 ] It could develop in any sites, including the skin, soft tissues, breast, liver, and spleen, and represent only 1% of primary malignant neoplasms in bone or marrow. [ 10 ] The mechanism of angiosarcoma is still unknown, while the related risk factors include previous exposure to radiation or some special chemotherapy for lymphoma.…”

Section: Discussionmentioning

confidence: 99%

“…[ 14 ] The prognosis of angiosarcoma is very poor with a 1-year survival rate less than 50%, and the elder age, larger tumor size, and retroperitoneal location are poorer prognostic factors. [ 5 , 15 – 19 ]…”

Section: Discussionmentioning

confidence: 99%

“…The prognosis of EAS is very poor with a high rate of early metastasis and tumor-related death. [ 5 , 9 , 17 , 19 , 43 ] An adequate surgery combined with the use of neoadjuvant and adjuvant chemoradiotherapy seems to improve the survival rate. [ 9 , 43 ] However, in our case, the patient presented to us with a multiple bone destruction.…”

Section: Discussionmentioning

confidence: 99%

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Right femoral pathological fracture caused by primary bone epithelioid angiosarcoma

Zou²,

Chang³

et al. 2017

Medicine

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Rationale:Epithelioid angiosarcoma (EAS) is an extremely rare malignant disease, which accounts no more than 1% of all soft tissue sarcomas. In this article, we would report a new case of EAS with multiple bone destruction and right femoral pathological fracture, which was an even rarer manifestation of EAS.Patient concerns:In this case, a 64-year-old man with right femoral fracture was reported. He had suffered from a progressive low back pain for about 8 months, and the imaging examinations prompted a multiple bone destruction in his vertebra and lower limbs. He then got a right femoral fracture without any obvious traumatic injury, and came to our hospital.Interventions:He underwent an operation of radical resection, bone cement filling and dynamic condylar screw internal fixation. During the operation, we found that the soft tissue around the fracture had a rotten fish change, which suggested a malignant disease.Diagnoses:The postoperative pathological diagnosis reported an EAS, which is extremely rare and highly malignant.Outcomes:The patient died in 83 days after the surgery, and the survival time from the symptoms started to the end was only 11 months, which showed a rapid progress and poor prognosis of EAS.Lessons:EAS is very hard to be diagnosed by clinical manifestation or radiological examinations. As in our case, pathological analysis is the final diagnosis. The images of the patient may offer some tips for the skeletal presentation of EAS, and do more help in future study of this disease.

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Rare case of spontaneous splenic rupture

Cited by 6 publications

References 3 publications

Delayed Splenic Rupture after Robotic Partial Nephrectomy

Delayed Splenic Rupture after Robotic Partial Nephrectomy

Atraumatic splenic rupture after cocaine use and acute Epstein-Barr virus infection: A case report and review of literature

Right femoral pathological fracture caused by primary bone epithelioid angiosarcoma

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