Spontaneous rupture of the spleen in chronic lymphocytic leukemia

Abstract

A case of spontaneous rupture of the spleen in a 67‐year‐old woman with chronic lymphocytic leukemia is presented. The patient had been hospitalized and treated with chlorambucil but had complained of left upper quadrant pain during and subsequent to her hospitalization. Immediately prior to death this became extremely severe and the patient exhibited weakness and nausea. At autopsy generalized lymphadenopathy and hepatosplenomegaly were noted. Other cases of spontaneous rupture of the spleen also are summarized from the literature. Only 32 cases have been found in leukemic patients and all but 3 have been in men. Although spontaneous rupture of the spleen is an unusual occurrence, the authors conclude that in some cases there is no history of injury or stress.

Splenic mass with remote trauma history: a management dilemma

“…Patients with pre-existing splenic pathology are at increased risk of splenic rupture following thoracoabdominal trauma. This is due to alterations in the splenic architecture and splenomegaly extending below the protective ribcage [2].…”

Delayed diagnosis of splenic rupture following minor trauma: Beware of comorbid conditions

“…In settings of splenic pathology, the spleen is more prone to rupture not only due to the altered consistency but Splenic rupture after minor trauma also due to the splenomegaly that extends the spleen below the rib cage. 5 Abdominal pain is the most common symptom of splenic rupture. 6 The character of the pain can be variable, from localized left upper-quadrant pain to left-sided chest pain to generalized abdominal pain.…”

“…3 Spontaneous rupture of the spleen associated with CLL has also been reported in the literature. 5,6 However, there are no reports of splenic injury secondary to minor trauma in CLL patients. This report describes one case of a seemingly trivial injury that lead to splenic laceration in a CLL patient.…”

Recommendations for gross examination and sampling of surgical specimens of the spleen

“…It is important to note that traumatic splenic injury is increasingly managed nonoperatively, leading to recently decreasing splenectomy rates for this indication. Splenectomy is occasionally required in the unlikely event of "spontaneous" or nontraumatic splenic rupture, associated with a broad range of etiologies (Table 2) [6][7][8][9][10][11][12][13][14]. Frequently, nontraumatic splenic rupture occurs secondary to acute infectious mononucleosis [8,13].…”