Abstract
IntroductionSplenic rupture most commonly results from a traumatic mechanism. Spontaneous splenic ruptures are a rare occurrence. This is an interesting and rare case of atraumatic splenic rupture (ASR) presented after sniffing cocaine. Presentation of caseThe patient presented with abdominal pain and tenderness with low hemoglobin on admission. The computed tomography (CT) scan of the abdomen showed possible spleen rupture with hemoperitoneum. An emergent laparotomy and total splenectomy was performed. The pathology confirmed splenomegaly and a large area of adhesion. Adjacent to the adhesion, a focal disruption of splenic parenchyma was found. DiscussionASR has been reported in the literature due to infection, inflammation, mechanical and use of certain drugs. Few cases of ASR have been described due to cocaine use. Splenomegaly is one of the risk factors of ASR. The most probable mechanism of ASR in cocaine use is sudden vasoconstriction, ischemia and infarction of the parenchyma of the spleen, which can result in vascular rupture. Our case of ASR echoes the above process. ConclusionTotal splenectomy resulted in a good outcome. The patient was discharged home without any services.
Highlights
Splenic rupture most commonly results from a traumatic mechanism
An additional unit of Packed Red Blood Cells (PRBCs) was transfused on post-operative day (POD) 3 to correct a low hemoglobin of 6.9 g/dl
While most splenic ruptures result from a traumatic mechanism, rare cases such as this exist without any attributable trauma
Summary
Splenic rupture most commonly results from a traumatic mechanism. Spontaneous splenic ruptures are a rare occurrence. This is an interesting and rare case of atraumatic splenic rupture (ASR) presented after sniffing cocaine. PRESENTATION OF CASE: The patient presented with abdominal pain and tenderness with low hemoglobin on admission. A focal disruption of splenic parenchyma was found. DISCUSSION: ASR has been reported in the literature due to infection, inflammation, mechanical and use of certain drugs. Few cases of ASR have been described due to cocaine use. The most probable mechanism of ASR in cocaine use is sudden vasoconstriction, ischemia and infarction of the parenchyma of the spleen, which can result in vascular rupture. CONCLUSION: Total splenectomy resulted in a good outcome.
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