Splenic rupture in patients with hematologic malignancies

Abstract

Five cases of pathologic rupture of the spleen in patients with hematologic malignancy are presented along with a review of the 48 cases previously described in the English literature. Pathologic splenic rupture occurred most commonly in patients with acute leukemia but has been well documented in chronic leukemias and in lymphoma as well. Nearly all patients experience abdominal pain at the time of rupture; however, this pain was frequently confused clinically with that of biliary tract obstruction, aortic aneurysm, perforated viscus, pancreatitis, and angina pectoris. Pain referred to the left shoulder (Kehr's sign) was present in only 17% of patients. Hypotension was documented in 66%, fever in 74%, and tachycardia in 75%. The most effective diagnostic procedure was paracentesis, which confirmed intraabdominal hemorrhage in each of the nine cases in which the procedure was used. A correct preoperative diagnosis of splenic rupture was reported in only 10 of the 53 cases reviewed. Fifty-two percent of the patients underwent laparotomy; 48% died without operation. Of those that underwent surgery, 78% survived the procedure and the immediate postoperative period. The survival rate of all patients was 38%. There was no correlation of the type of hematologic malignancy, occurrence or type of treatment, peripheral blood counts, or spleen size to survival. The most important factor in predicting survival was appropriate surgery.

Non-traumatic splenic rupture: Report of seven cases and review of the literature

“…Diagnosis is based on clinical symptoms and confirmatory diagnostic tests. Some authors have reported that paracentesis is the most effective diagnostic procedure [4,39] . Abdominal ultrasound is an inexpensive and practical way to obtain a quick diagnosis of intraperitoneal fluid accumulation or hematoma, which can be performed at the patient's bedside or in the emergency unit [28] .…”

“…NSR usually occurs in a diseased spleen and is called a pathologic rupture [2] . Infection, malignancy, metabolic disorders, as well as vascular and hematological diseases, of which only single case reports have been published in the literature, are the usual reasons [3][4][5] . Recently, some authors have reported that spontaneous splenic rupture has been seen as a factor in malaria [6,7] , aortic valve replacement for bacterial endocarditis [8] , normal spleen [9] , factor Ⅷ deficiency, which is a rare autosomal bleeding disorder with a frequency of 1:2 000 000 in the general population [10] , and autologous transplantation for primary systemic amyloidosis [11] .…”

Pathologic rupture of the spleen in hematologic malignancies: two additional cases

“…Three pathogenetic factors have so far been advanced to explain the occurrence of pathologic splenic rupture: infiltration of the spleen by the hematologic disease with changes in its histologic structure, splenic infarcts inducing areas of reduced resistance, and coagulation disorders leading to intrasplenic and subcapsular bleeding and ultimately resulting in capsular rupture [5]. 1 Splenic weight distribution for specific hematologic diseases.…”

Pathological splenic rupture: A rare complication of chronic myelomonocytic leukemia

“…A healthy spleen does not rupture without significant trauma; therefore any ''spontaneous'' rupture should prompt a search by the clinician for underlying splenic pathology. Several possible mechanisms have been proposed for splenic rupture in a patients with hematological disorders [7]. Most commonly, malignant cells of lymphoproliferative and myeloproliferative origin infiltrate the spleen directly.…”