Two rare cases of spontaneous splenic rupture

Randriamarolahy, Anja; Cucchi, Jean-Michel; Brunner, Philippe; Garnier, G.; Demarquay, J. F.; Bruneton, J.

doi:10.1016/j.clinimag.2009.09.004

Cited by 7 publications

(7 citation statements)

References 10 publications

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“…Thus, usage of the term spontaneous was inconsistent and continues to be so in the more recent literature, with many authors labeling the rupture of diseased spleens as spontaneous. We highlight this because many of the pathological ruptures that we have documented here (as well as pathological ruptures in patients with previously known disease documented elsewhere [6]) include the word spontaneous in the title and no information on the associated pathology [8,61,91,98,124,151,154,355-357,365,400,403]. Thus, readers skimming titles may be mistaken in thinking that true spontaneous rupture is more common than thought.…”

Section: Discussionmentioning

confidence: 99%

613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review

2012

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BackgroundRupture of the spleen in the absence of trauma or previously diagnosed disease is largely ignored in the emergency literature and is often not documented as such in journals from other fields. We have conducted a systematic review of the literature to highlight the surprisingly frequent occurrence of this phenomenon and to document the diversity of diseases that can present in this fashion.MethodsSystematic review of English and French language publications catalogued in Pubmed, Embase and CINAHL between 1950 and 2011.ResultsWe found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size) spleens in 35 cases and after minor trauma in 23 cases. Medications were implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its complications in 38 cases.The most common associated diseases were infectious (n = 143), haematologic (n = 84) and non-haematologic neoplasms (n = 48). Amyloidosis (n = 24), internal trauma such as cough or vomiting (n = 17) and rheumatologic diseases (n = 10) are less frequently reported. Colonoscopy (n = 87) was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n = 6), infarction (n = 6) and hamartomata (n = 5). Medications associated with rupture include anticoagulants (n = 21), thrombolytics (n = 13) and recombinant G-CSF (n = 10). Other causes or associations reported very infrequently include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm, cholesterol embolism, splenic granuloma, congenital diaphragmatic hernia, rib exostosis, pancreatitis, Gaucher's disease, Wilson's disease, pheochromocytoma, afibrinogenemia and ruptured ectopic pregnancy.ConclusionsEmergency physicians should be attuned to the fact that rupture of the spleen can occur in the absence of major trauma or previously diagnosed splenic disease. The occurrence of such a rupture is likely to be the manifesting complaint of an underlying disease. Furthermore, colonoscopy should be more widely documented as a cause of splenic rupture.

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Section: Discussionmentioning

confidence: 99%

613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review

2012

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“…Being aware of this diagnosis and being able to identify the symptoms of such a patient can lead to a faster, life-saving diagnosis. Most patients with a colonoscopy-induced splenic rupture present with the typical symptoms of a trauma-induced splenic rupture within 24 hours of their colonoscopy [1–14]. However, some patients do have delayed presentation several days later [12].…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasonography (US) is a useful test for diagnosing this condition, is rapid, and does not have radiation exposure and intravenous contrast risks. However, US is the best for identifying the presence of free fluid in the peritoneum and further imaging, such as a CT, is better for delineation of the extent of injury to the spleen [2, 14]. In patients that are hemodynamically stable, this test is the gold standard for the evaluation and assessment of splenic injury [1, 2, 4, 6, 8, 9, 11, 15].…”

Section: Discussionmentioning

confidence: 99%

“…The majority of previously reported cases were managed by splenectomy [1, 2, 4, 6–8, 10–12, 14]. Patients that are hemodynamically stable can be managed successfully with conservative treatment consisting of observation, IV fluids, and blood transfusions as needed [5, 13].…”

Section: Discussionmentioning

confidence: 99%

“…Yet none of these factors was found to be common among any of the patients in the various reports. Also, complication during colonoscopy [1, 2, 6, 7, 9–14] and abnormal spleen histology [1, 4, 7–12, 14] are not risk factors. …”

Section: Discussionmentioning

confidence: 99%

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Acute Colonoscopy-Induced Splenic Rupture Presenting to the Emergency Department

Chow

Shih

2013

Case Reports in Emergency Medicine

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Splenic rupture due to colonoscopy is a rarely reported event in the emergency medicine literature. Patients experiencing such an occurrence are likely to report to the emergency department. This paper documents an 84-year-old female who presented to the emergency department with abdominal pain and nausea less than 24 hours following a colonoscopy. An abdominal ultrasound revealed splenomegaly and free fluid. An abdominal computed tomography was significant for a splenic laceration. She underwent radiologic guided embolization and recovered without incident. Emergency medicine physicians need to consider splenic rupture as a differential in patients presenting after colonoscopy with abdominal pain.

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Splenic artery embolisation for splenic injury during colonoscopy: A systematic review

Lukies,

Clements

2023

UEG Journal

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BackgroundSplenic injury due to colonoscopy is rare, but has high mortality. While historically treated conservatively for low‐grade injuries or with splenectomy for high‐grade injuries, splenic artery embolisation is increasingly utilised, reflecting modern treatment guidelines for external blunt trauma. This systematic review evaluates outcomes of published cases of splenic injury due to colonoscopy treated with splenic artery embolisation.MethodsA systematic review was performed of published articles concerning splenic injury during colonoscopy treated primarily with splenic artery embolisation, splenectomy, or splenorrhaphy from 1977 to 2022. Datapoints included demographics, past surgical history, indication for colonoscopy, delay to diagnosis, treatment, grade of injury, splenic artery embolisation location, splenic preservation (salvage), and mortality.ResultsThe 30 patients treated with splenic artery embolisation were of mean age 65 (SD 9) years and 67% female, with 83% avoiding splenectomy and 6.7% mortality. Splenic artery embolisation was proximal to the splenic hilum in 81%. The 163 patients treated with splenectomy were of mean age 65 (SD 11) years and 66% female, with 5.5% mortality. Three patients treated with splenorrhaphy of median age 60 (range 59–70) years all avoided splenectomy with no mortality. There was no difference in mortality between splenic artery embolisation and splenectomy cohorts (p = 0.81).ConclusionsSplenic artery embolisation is an effective treatment option in splenic injury due to colonoscopy. Given the known benefits of splenic salvage compared to splenectomy, including preserved immune function against encapsulated organisms, low cost, and shorter hospital length of stay, embolisation should be incorporated into treatment pathways for splenic injury due to colonoscopy in suitable patients.

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Two rare cases of spontaneous splenic rupture

Cited by 7 publications

References 10 publications

613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review

613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review

Acute Colonoscopy-Induced Splenic Rupture Presenting to the Emergency Department

Splenic artery embolisation for splenic injury during colonoscopy: A systematic review

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