Spontaneous splenic rupture due to occult signet‐ring cell gastric cancer accompanied by a bulky splenic vein thrombosis and postoperative brain infarction: A case report

Abstract

BackgroundSplenic rupture because of metastasis from a distant organ is extremely rare.Case PresentationAn 80‐year‐old man presented with left flank pain. A computed tomography (CT) demonstrated a poorly enhanced enlarged spleen with bulky thrombus in the splenic vein without extravasations. A CT on the following day showed increased intraperitoneal hemorrhage; therefore, an emergency laparotomy was performed. The spleen was enlarged and ruptured with lacerations on its surface. Macroscopic examination showed congestion with a thrombus in the splenic vein around the hilum. Pathology revealed signet‐ring cell carcinoma. On the third postoperative day, a massive cerebral infarction in the left middle cerebral artery was revealed. Endoscopic examination demonstrated normal gastric mucosa except for some erosions, for which biopsies were performed, and two of five specimens encompassed signet‐ring cell carcinoma in the lamina propria.ConclusionOccult cancer could result in a drastic manifestation of its metastasis accompanying systemic thrombotic events.

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

“…This rarity underscores the importance of maintaining a broad differential diagnosis when evaluating young patients with acute abdominal pain. The pathophysiology behind the spontaneous rupture of a structurally normal spleen remains speculative [10][11][12][13][14]. Increased intrasplenic tension due to congestion, vascular anomalies, or enzymatic digestion of the splenic capsule are proposed mechanisms.…”