Case Report–Spontaneous Splenic Rupture–A Rare Complication of Haematological Malignancies

Abstract

IntroductionSpontaneous splenic rupture is an abdominal catastrophewith patient presenting with haemodynamic instability. Thisrequires urgent diagnosis and emergency surgery. Themajority of the cases of splenic rupture are those ofdiseased spleen and are called pathological rupture ofspleen [1]. True spontaneous rupture which is very rare, isthe rupture of normal spleen. Haemato-oncological malig-nancies are often incriminated as a cause of pathologicalrupture of spleen [1]. Splenomegaly is a very commonpresentation of chronic myeloid leukaemia. However theprogression of splenomegaly in chronic myeloid leukaemiais usually slow and insidious that many patients may not beaware of it until spleen has become huge in size [2].Pathogenesis of rupture includes congestion of theparenchyma by blast cells and intrasplenic hemorrhagecaused by coagulation abnormalities and splenic infarction.Splenic ruptures usually occur in enlarged spleens [1].Here we present a case of 40 year male who was a knowncase of chronic myeloid leukaemia who presented in emergen-cy with left upper quadrant paint and abdominal distention.Patient was haemodynamically unstable. After doing ultra-sound and computed tomography diagnosis of spontaneoussplenic rupture was made. Patient was operated and spleenec-tomy was done. Patient was stable post operatively.Case ReportWe present a case of 40 year old male who wasdiagnosed as chronic myeloid leukaemia 6 months backon basis of peripheral blood film and bone marrow. Hisspleen was enlarged in size. Patient did not receive anytreatment for this.He presented in the emergency with left upper quadrantpain and progressively increasing abdominal distention. Onexamination patient was mildly febrile and pale. He washaving cold and clumsy skin. His pulse was 136/min andBP was 94/60. Heart and lungs were normal. No pasthistory of trauma was there.Perabdominal ExaminationAbdomen was distended with left upper quadrant tender-ness guarding and rigidly were present. Spleen wasenlarged in size. Investigations showed low Hb of 7.4 gmwith increased TLC of 1,24,000 with neutrohils 84% andPCVof 21.6%. After the examination provisional diagnosisof acute pancreatitis was made. Ultrasonography andcomputed tomography was done.Ultrasound showed marked splenomegaly and largeperisplenic and intra splenic haemotoma (Fig. 1)Computed TomographyComputed tomography was performed on a multi detectorduel source CT Scanner by Siemens (128 slice) usingstandard protocols.Computed tomography revealed a large intraperitonealhematoma in the left upper quadrant extending from leftsubphrenic space till lumbar region. Spleen was notseparately visualized. Splenic arlery was not opacified