Atraumatic splenic rupture

Abstract

Atraumatic splenic rupture is an uncommon but poorly defined clinical condition. Its diagnosis may be missed or delayed because of low clinical suspicion, especially in the absence of trauma. The primary aim of this study was to describe the experience with atraumatic splenic rupture in a district general hospital. Over a 6-year period (2004-2010), seven patients were identified, producing an incidence of 1.2/year. Computed tomography confirmed the diagnosis preoperatively in all the cases where it was performed (n=5). All patients required total splenectomy; indications included peritonitis, hypovolaemic shock and failed conservative treatment. Five splenectomies were performed within 24 h of admission. In four cases, no pathological abnormality was identified (atraumatic-idiopathic); abnormal pathologies (atraumatic-pathological) in the remaining three were amyloidosis, lymphoma and focal thrombosis. A high index of suspicion should be maintained by emergency physicians and surgeons during initial evaluation of these patients. Computed tomography scan facilitates the diagnosis and early total splenectomy is often needed.