Spontaneous Splenic Artery Rupture as the First Symptom of Systemic Amyloidosis.

Øyvind Bruserud,Tor Henrik Anderson Tvedt,Tor Hervig,Olav Karsten Vintermyr,Anne Berit Guttormsen,Håkon Reikvam,Aymen Bushra Ahmed,Chiara Lazzeri

doi:10.1155/2021/6676407

Øyvind Bruserud, Tor Henrik Anderson Tvedt + Show 6 more

Open Access

https://doi.org/10.1155/2021/6676407

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Abstract

Spontaneous splenic rupture is a life-threatening condition leading to a rapidly progressing hypovolemic shock due to intra-abdominal blood loss, with a mortality rate of about 10%. Spontaneous splenic rupture can be caused by widely different disorders including acute and chronic infections, neoplastic disorders, and inflammatory noninfectious disorders. In this case report, we present a 67-year-old male patient with hemorrhagic shock caused by an acute bleeding from the splenic artery. The patient was massively transfused with blood products and fluids and underwent laparotomy for hemostatic control and clinical stabilization. Multiorgan involvement by amyloid light-chain amyloidosis (AL-amyloidosis) caused by plasma cell dyscrasia, specifically with infiltration of the spleen artery, was found to be the underlying cause of his life-threatening bleeding. Based on this case, we discuss the features of serious spleen bleeding, massive transfusion therapy in the intensive care setting, and AL-amyloidosis pathophysiology and treatment.

Highlights

Spontaneous splenic rupture can be caused by several different disorders including acute and chronic infections, neoplastic disorders, and inflammatory noninfectious disorders and has the potential to cause a hemorrhagic lifethreatening form of hypovolemic shock [1]
Injuries that penetrate the capsule result in an acute bleeding, while damage to the parenchymal tissue leads to subcapsular hematoma and a delayed rupture
We present a 67-year-old male patient with hemorrhagic shock caused by an acute bleeding from the splenic artery

Summary

Introduction

Spontaneous splenic rupture can be caused by several different disorders including acute and chronic infections, neoplastic disorders, and inflammatory noninfectious disorders and has the potential to cause a hemorrhagic lifethreatening form of hypovolemic shock [1]. Injuries that penetrate the capsule result in an acute bleeding, while damage to the parenchymal tissue leads to subcapsular hematoma and a delayed rupture. Splenic rupture is a wellknown entity, it is relatively rarely occurring, and only a very few studies have systematically evaluated its pathophysiology and outcome. In this case report, we present a 67-year-old male patient with hemorrhagic shock caused by an acute bleeding from the splenic artery. Multiorgan involvement by amyloid light-chain (AL-) amyloidosis was found to be the underlying cause of bleeding

Case Report

RCC 4 plasma

Findings

Discussion

Conclusion