Diffuse lymphocytic lymphoma with splenic rupture.

Abstract

WHEN the splenic capsule is found to be lacerated or the spleen avulsed from its pedicle, it is almost always due to recent injury. Occasionally, a patient will present as an acute abdominal emergency with or without the signs of haemorrhage but no history of recent injury, and at laparotomy, rupture of the spleen will be found. If, in such circumstances, careful questioning has failed to reveal a history of trauma or unusual effort, and on examination of the spleen, both macroscopically and microscopically, no abnormality apart from the haemorrhage and laceration can be found, then such an example can be truly labelled spontaneous rupture of the normal spleen. Such an event is but rarely reported. Orloff & Peskin in 1958, after reviewing seventy-one reported cases in the literature, considered only twenty to be fully acceptable. Seven years later, Naiberg and his colleagues (Naiberg, Sidlofsky & Chris, 1965) reported a case conforming to the above criteria but were able to add only two further examples. Much commoner is sudden rupture of the diseased spleen and this event has been recorded in a wide range of splenic diseases. In this context, a controversial point which recurs in the literature concerns the interpretation of the meaning of the term 'spontaneous'. Whereas in 1964, Hynes, Silverstein & Fawcett found seventeen examples of spontaneous rupture of the spleen in leukaemia, Stiles & Ultman in 1966 in reviewing thirty-two cases of rupture of the leukaemic spleen accepted only eight as being truly spontaneous in origin. The following is a case report of rupture of the diseased spleen in the absence of any trauma.