Splenic Artery Embolization and Splenectomy for Spontaneous Rupture of Splenic Hemangioma and Its Imaging Features

Abstract

BackgroundSpontaneous splenic rupture (SSR) is a rare, often life-threatening, acute abdominal injury that requires immediate diagnosis and early treatment. SSR is mainly treated surgically or conservatively. A few cases of interventional embolization for SSRs have been reported.Case PresentationA 30-year-old male patient complaining mainly of left upper abdominal pain underwent emergency abdominal computed tomography (CT) and showed enlargement of the spleen with a massive mixed-density shadow approximately 10.0 × 8.0 × 12.5 cm in size. The boundary was unclear and showed obvious progressive enhancement. Considering the intrasplenic tumor lesions with rupture and hemorrhage, the possibility of vascular tumors was high, with intraperitoneal blood and fluid accumulation. Digital subtraction angiography of the splenic arteriography and embolization of the ruptured splenic artery branches were performed. Postoperative hemoglobin progressively decreased, inflammatory indicators, such as white blood cell counts, procalcitonin (PCT), and C-reactive protein (CRP) were significantly increased, and 2 days after embolization, the patient developed severe hypoxemia, shock, pulmonary edema, and acute respiratory distress syndrome. CT re-examination 9 days after embolization showed reduced lesion absorption. After stabilization of the condition, splenectomy was performed, and postoperative platelet count increase, anticoagulant improvement, and discharge were observed. Postoperative pathological examination revealed extensive hemorrhage and necrosis, vascular tissue with abnormal hyperplasia in the surrounding area, vascular tissue in the bleeding area and outer wall (elastic fiber staining +), and local myofibroblast hyperplasia. Immunohistochemistry showed actin (SM +) and Ki67 (10% +).ConclusionSSR caused by splenic hemangioma is rare, and the choice between surgical treatment or splenic artery embolization remains dependent on the patient's hemodynamic stability and imaging findings.

Primary Spontaneous Splenic Rupture: A Rare and Life-Threatening Condition

“…Surgical intervention, such as splenectomy or partial splenectomy, remains the mainstay of treatment, although non-operative management may be considered in this case. Additionally, it is important to address any underlying predisposing conditions, such as infectious mononucleosis or hematologic disorders, to prevent recurrence (Lin et al, 2022). The presented case serves as a reminder of the complexities inherent in medical diagnoses and ensuring the well-being of patients facing rare and challenging conditions like spontaneous splenic rupture.…”

Spontaneous Splenic Rupture in a Young Patient: A Comprehensive Case Report and Literature Review

“…The decision to perform a splenectomy, as opposed to spleen-preserving procedures, is often guided by the intraoperative findings and the patient’s overall condition. Emergency splenectomy remains the cornerstone treatment for splenic rupture, as delaying treatment can lead to catastrophic clinical outcomes [ 16 , 17 ]. The post-operative management of patients who have undergone splenectomy, especially regarding vaccination against encapsulated organisms, is crucial.…”

Spontaneous splenic rupture associated with influenza B virus

“…In a large systematic review of ASR Renzulli et al found that of 774 patients, 85.3% underwent surgery within 24 hours and of the remainder managed non-surgically, 17% eventually underwent secondary www.annscri.org splenectomy due to rebleeding and haemodynamic compromise [2]. However the benefits of non-surgical management must not be disregarded due to the spleens fundamental role in immunity and conferring protection against encapsulated organisms [4]. The underlying aetiological association of ASR is expansive and can be broadly categorised into distinct subgroups [2,5].…”