Atraumatic Splenic Rupture Research Articles

Spontaneous Splenic Rupture Secondary to Infectious Mononucleosis.

Spontaneous splenic rupture (SSR) is a relatively rare but potentially lethal complication of infectious mononucleosis (IM). While SSR is extremely rare in patients with proven IM, it is the most lethal complication of the infection (9% mortality rate) and can present completely asymptomatically or with abdominal pain and hemodynamic instability. As adolescents and young adults are the most affected population group, with this case report, we intend to raise the vigilance of any doctor treating those patients in the emergency department. We present the case of a 16-year-old patient with an atraumatic splenic rupture and hemoperitoneum secondary to an Epstein-Barr virus (EBV) infection. The patient underwent an exploratory laparotomy, and a splenectomy was performed. This case demonstrates that, even if SSR in patients with IM is extremely rare, it should always be considered in a patient with a relevant clinical presentation.

Spontaneous splenic rupture and a congenital splenorenal anomalous shunt.

Atraumatic splenic rupture is rare and not often considered in the differential diagnosis for patients with abdominal pain. This article describes a patient with atraumatic splenic rupture complicated by a congenital splenorenal anomalous shunt. The congenital anomaly increases patient risk and the degree of surgical difficulty, even if it is identified preoperatively.

Transcatheter Arterial Embolization for Atraumatic Splenic Rupture in TEE-negative Endocarditis: A Case Report.

Spontaneous splenic rupture is an extremely rare complication of infective endocarditis. We present a case of a 56-year-old immunocompetent female with porcine bioprosthetic mitral valve replacement, automated implanted cardioverter-defibrillator, and atrial fibrillation on apixaban who was found to have in-hospital atraumatic splenic rupture complicating infective endocarditis with Haemophilus parainfluenza. The rupture was treated successfully by endovascular embolization. Usual treatment with six weeks of antibiotics provided durable cure without further complication, and no surgical intervention was needed for either the valve or spleen. Transcatheter arterial embolization should be considered early in atraumatic splenic rupture. Relevant abdominal and cerebral imaging should be considered in all cases of suspected or confirmed infective endocarditis where unexplained symptoms are present.

Spontaneous splenic rupture associated with influenza B virus

Atraumatic Splenic Rupture (ASR) is rare relative to traumatic cases, being referred to as a spontaneous rupture in the presence of a histologically proven normal spleen. ASR carries with it a risk of mortality which has been reported to be as high as 12.2%, given the life-threatening potential a prompt diagnosis and subsequent management is critical. However, the aetiology of ASR is wide ranging and often and the clinical diagnosis can be obscured by signs and symptoms being attributed to the underlying disease process, thus requiring a high index of clinical suspicion. We present the first documented case of a spontaneous splenic rupture associated with Influenza B virus in English literature.

Epstein-Barr Virus-Associated Atraumatic Splenic Rupture.

Teaching point: Atraumatic splenic rupture is a rare but life-threatening complication of infectious mononucleosis.

Atraumatic Splenic Rupture in a Neonate: A Case Report

Idiopathic atraumatic splenic rupture (ASR) is rare, especially in neonates and can result in the spontaneous hemorrhage of the organ, abdominal distension, and hemoperitoneum. This condition can be fatal without prompt diagnosis and surgical intervention. The pathophysiology of ASR is difficult to understand due to its rarity; however, retrospective reviews have found an association with neoplasm, infection, inflammatory diseases, and anticoagulant drugs. Therefore, it is essential to report this rare occurrence. This case report involves a 2-day-old neonate born to a mother with chronic hypertension, chorioamnionitis, and a carrier of cystic fibrosis. An abdominal sonogram followed by contrast-enhanced computed tomography (CT) revealed hemoperitoneum with possible active bleeding and lack of definite visualization of the spleen. During emergency laparotomy, the attempt to preserve the organ was unsuccessful, requiring splenectomy. The neonate recovered well from the procedure and was discharged on the 18th day of life.

Atraumatic splenic rupture as first manifestation of different underestimated clinical conditions

Atraumatic splenic rupture as first manifestation of different underestimated clinical conditions

Spontaneous Splenic Rupture - A Rare Complication of Cirrhosis with Portal Hypertension: A Case Report

Spontaneous rupture rupture in cirrhotic patients with portal hypertension is a rare complication; however, the incidence, etiology and risk of rupture have not been established. The diagnosis is confirmed by abdominal imaging or exploratory laparotomy and treatment is essentially surgical. We report a case of atraumatic splenic rupture in a 30-year- old woman with hepatic cirrhosis associated with splenomegaly.

Acute necrotizing pancreatitis with hemorrhagic shock in secondary splenic rupture: a case report and literature review

Atraumatic splenic rupture is a rare complication of acute and chronic pancreatitis. It arises due to its anatomical proximity to the pancreas, for instance, due to erosion of large pseudocysts or walled-of-necrosis (WON).Following we describe the case of a 62-year-old woman who presented for further diagnostics and treatment of acute pancreatitis with the development of large walled-of necrosis (WON) in the pancreatic corpus and tail. During the course, the patient developed a hemorrhagic shock. An emergency computer tomography (CT) of the abdomen revealed a ruptured spleen with a large capsular hematoma with no evidence of active bleeding. In contrast to previous published case reports, our treatment was exclusively minimal-invasive: by radiological guided embolization of the splenic artery and by endosonographic guided implantation of a lumen apposing metal stent (LAMS). The splenic hematoma was spontaneously regressive without secondary drainage.

Atraumatic splenic rupture in COVID-19 era: case report and systematic literature review.

Atraumatic splenic rupture is a rare but life-threatening condition. The Coronavirus disease 2019 (COVID-19) is still a mysterious infection, often associated with spontaneous bleeding and coagulation disorders. Among them, a rare presentation is the atraumatic splenic rupture during SARS-CoV-2 infection. We reported the case of a COVID-19 patient that underwent splenectomy for a spontaneous splenic rupture without splenomegaly or any hematological disorders. Moreover, we reviewed the literature about this matter focusing on the hypothetical etiopathogenesis of this condition in COVID-19 patients. Twelve cases of atraumatic splenic rupture without splenomegaly were reported in ten papers. Coughing, respiratory tract infections and anticoagulant treatment were postulated as the main risk factors for the spontaneous splenic rupture. COVID-19 is still a not well-known disease with multiple clinical presentations. The spontaneous splenic rupture is uncommon in general population but this event should not be neglected in this particular subset of patients.

Spontaneous Splenic Rupture in A Non-Hodgkin Lymphoma Patient, A Rare Case Report

Splenic rupture with no history of previous trauma is known as spontaneous splenic rupture or atraumatic splenic rupture. Most patients have high mortality rates due to missed or delayed diagnosis. In this case report, a 41-year -old male patient who presented with jaundice developed a spontaneously ruptured spleen. One of the misleading clues to this patient's clinical situation was the previous free surgical and medical history with no known predisposing factors at the time of splenic rupture diagnosis.

875 Atraumatic Splenic Rupture Secondary to Ruptured Pancreatic Pseudo Cyst- a Rare Phenomenon

Abstract Introduction Chronic pancreatitis can be complicated by the development of a pancreatic pseudocyst in 20 – 40% of cases. Splenic rupture is usually associated with blunt trauma but can be associated with non-traumatic causes like pancreatic pseudocysts associated with chronic pancreatitis. Atraumatic splenic rupture (ASR) is rare, and a life-threatening process with a mortality of about 12%. Possible mechanisms of action of pancreatic pseudocysts causing ASR to have been described in literature, with some of them involving the action of proteolytic enzymes on the splenic vessels, parenchyma and hilum. Management of these cases involves resuscitation, and emergency splenectomy because they usually present with haemodynamic instability. Case report A 50-year-old woman with a background of pancreatic pseudocyst secondary to alcoholic chronic pancreatitis presented with severe left sided abdominal pain. A Computed Tomography (CT)scan confirmed the presence of splenic rupture with moderate haemoperitoneum. Emergency laparotomy revealed a ruptured and necrotic spleen adjacent to a ruptured pancreatic pseudocyst. A splenectomy was performed with abdominal packs left insitu with the view to a relook surgery 24 /48 hours later. She recovered uneventfully after HDU care. Conclusions ASR secondary to pancreatic pseudocyst as a complication of chronic pancreatitis is a rare phenomenon which requires a high index of suspicion for diagnosis. CT is the gold standard imaging modality for investigation in a haemodynamically stable patient. Management is surgical with adequate resuscitation and perioperative critical care.

Proteomic Identification and Clinicopathologic Characterization of Splenic Amyloidosis.

The spleen is a commonly encountered specimen in surgical pathology. However, little is known about the incidence, morphologic pattern, and clinical features of spleens involved by amyloidosis. We retrospectively identified 69 spleen amyloid cases typed using a proteomics-based method between 2008 and 2020. The frequency of amyloid types, clinicopathologic features, and distribution of amyloid deposits were assessed. Four amyloid types were detected: immunoglobulin light chain (AL) (N=30; 43.5%); leukocyte chemotactic factor 2 amyloidosis (ALECT2) (N=30; 43.5%); amyloid A (AA) (N=8; 11.6%); and fibrinogen alpha (AFib) (N=1; 1.4%). The splenic amyloid showed 5 distinct distribution patterns: (1) diffuse pattern, exhibited by most AL cases; (2) red pulp pattern, exhibited by most ALECT2 cases; (3) multinodular pattern, seen in subsets of AA and AL-kappa cases; (4) mass-forming pattern, seen in the AFib case; and (5) vascular only, seen in a subset of AA cases. Atraumatic splenic rupture was the most common reason for splenectomy in AL cases, while most ALECT2 spleens were removed incidentally during an unrelated abdominal surgery. Splenomegaly was significantly more common in AA spleens than in AL or ALECT2 spleens and was often the reason for splenectomy in this group. In conclusion, splenic amyloid may be underrecognized as it is often an incidental finding. Although, as expected, many of the spleens were involved by AL amyloidosis, ALECT2 emerged as another common spleen amyloid type. Although the spleen amyloid types exhibited characteristic distribution patterns, proteomics-based typing is warranted as some morphologic overlap still exists. Awareness of ALECT2 as a major spleen amyloid type is important for appropriate diagnostic workup and patient management.

Atraumatic splenic rupture in a patient after apixaban use and radiologically inserted gastrostomy – a case report

Andrius Račiūnas1 1Royal London Hospital, Barts Health NHS Trust, Ear, Nose & Throat Department, London, United Kingdom Abstract: Introduction. Atraumatic splenic rupture (ASR), also known as spontaneous splenic rupture, is a rare, potentially life-threatening condition that can be a result of infection, malignancy, inflammation, and a complication of various surgical procedures. There are not enough studies about patient characteristics, incidence rates, aetiology, and guidelines for management associated with ASR. Clinical case. A 53-year-old gentleman had a transoral robotic resection of the left tongue base/aryepiglottic fold carcinoma and level 2-4 neck dissection. Subsequently, he had a radiologically inserted gastrostomy (RIG) for his dysphagia and airway protection. Two days after RIG was inserted, the patient collapsed in the ward. Blood tests were done and showed a severe haemoglobin level drop from 123 g/L to 73 g/L. Computer Tomography (CT) of the abdomen showed splenic bleeding. He had emergency laparotomy with splenectomy which showed no signs of traumatic spleen rupture secondary to RIG insertion. A histopathology sample taken in theatre showed no pathological changes in the spleen. There were no other causes apart from apixaban which was stopped before the procedure and resumed 24 hours after RIG insertion. Conclusion. ASR is a rare event in healthcare and the symptoms are not specific. Abdominal pain on the left side that can spread to the shoulder, a decrease in haemoglobin level, and signs of haemorrhagic shock are all possible signs of bleeding in the spleen. Anticoagulant therapies such as apixaban, rivaroxaban, direct-acting oral anticoagulants (DOAC), and dabigatran are linked to instances of ASR. Keywords. Atraumatic splenic rupture, splenectomy, radiologically inserted gastrostomy, apixaban.

Transjugular intrahepatic portosystemic shunt, local thrombaspiration, and lysis for management of fulminant portomesenteric thrombosis and atraumatic splenic rupture due to vector-vaccine-induced thrombotic thrombocytopenia: a case report

IntroductionRecombinant adenoviral vector vaccines against severe acute respiratory syndrome coronavirus 2 have been observed to be associated with vaccine-induced immune thrombotic thrombocytopenia. Though vaccine-induced immune thrombotic thrombocytopenia is a rare complication after vaccination with recombinant adenoviral vector vaccines, it can lead to severe complications. In vaccine-induced immune thrombotic thrombocytopenia, the vector vaccine induces heparin-independent production of platelet factor 4 autoantibodies, resulting in platelet activation and aggregation. Therefore, patients suffering from vaccine-induced immune thrombotic thrombocytopenia particularly present with signs of arterial or venous thrombosis, often at atypical sites, but also signs of bleeding due to disseminated intravascular coagulation and severe thrombocytopenia. We describe herein a rare case of fulminant portomesenteric thrombosis and atraumatic splenic rupture due to vaccine-induced immune thrombotic thrombocytopenia.Case summary (main symptoms and therapeutic interventions)This case report presents the diagnosis and treatment of a healthy 29-year-old male Caucasian patient suffering from an extended portomesenteric thrombosis associated with atraumatic splenic rupture due to vaccine-induced immune thrombotic thrombocytopenia after the first dose of an adenoviral vector vaccine against severe acute respiratory syndrome coronavirus 2 [ChAdOx1 nCoV-19 (AZD1222)]. Therapeutic management of vaccine-induced immune thrombotic thrombocytopenia initially focused on systemic anticoagulation avoiding heparin and the application of steroids and intravenous immune globulins as per the recommendations of international societies of hematology and hemostaseology. Owing to the atraumatic splenic rupture and extended portomesenteric thrombosis, successful management of this case required splenectomy with additional placement of a transjugular intrahepatic portosystemic shunt to perform local thrombaspiration, plus repeated local lysis to reconstitute hepatopetal blood flow.ConclusionThe complexity and wide spectrum of the clinical picture in patients suffering from vaccine-induced immune thrombotic thrombocytopenia demand an early interdisciplinary diagnostic and therapeutic approach. Severe cases of portomesenteric thrombosis in vaccine-induced immune thrombotic thrombocytopenia, refractory to conservative management, may require additional placement of a transjugular intrahepatic portosystemic shunt, thrombaspiration, thrombolysis, and surgical intervention for effective management.

Atraumatic splenic rupture in a child with COVID 19

BackgroundThe majority of children with COVID-19 have only minor symptoms or none at all. COVID-19, on the other hand, can cause serious illness in some children, necessitating hospitalization, intensive care, and invasive ventilation. Many studies have revealed that SARS-CoV-2 affects not only the respiratory system, but also other vital organs in the body. We report here a child with an atraumatic splenic rupture as the initial and only manifestation of COVID-19.Case presentationA 13-year-old boy with clinical signs of acute abdomen, left-sided abdominal pain, and hemodynamic instability was admitted to the PICU in critical condition. His parents denied any trauma had occurred. In addition to imaging tests, a nasopharyngeal swab was taken for COVID-19 testing, which was positive. The thoracic CT scan was normal, whereas the abdominal CT scan revealed hemoperitoneum, splenic rupture, and free fluid in the abdomen.ConclusionsThe spleen is one of the organs targeted by the SARS-CoV-2. Splenic rupture, a potentially fatal and uncommon complication of COVID-19, can be the first and only clinical manifestation of the disease in children. All pediatricians should be aware of the possibility of atraumatic splenic rupture in children with COVID-19.

Characteristics and surgical outcomes of patients with atraumatic splenic rupture.

ObjectiveAlthough rare, late-diagnosed atraumatic splenic rupture (ASR) may result in mortality. We investigated the occurrence of ASR cases at our centre over the previous six years.MethodsThis was a retrospective, cross-sectional study that included all patients who underwent emergency splenectomy due to ASR between January 01, 2015, and January 01, 2021.ResultsOf the 203 patients who underwent splenectomy, 15 met our criteria for ASR. Median age was 55 years (34–90), and 10 (67%) patients were male. Most common pre-existing diseases were diabetes mellitus (6, 40%) and heart valve disease (5, 33%). Ten (67%) patients had splenic rupture due to splenic infarction and abscess. There were two (13%) cases with diffuse large B cell lymphoma (DLBCL) and two (13%) cases with lung cancer and spleen metastasis. Median length of hospital stay was 6 days (2–24) and three (20%) patients died in hospital.ConclusionsMale sex, previous splenic infarctions, haematological malignancies, lung cancer spleen metastases, underlying cardiovascular disease and diabetes mellitus may increase the risk for ASR. Further prospective controlled studies are needed to confirm our results.

Atraumatic Spleen Rupture Presenting as Acute Abdominal Pain: A Case Report

Splenic rupture is a potentially life-threatening condition associated with acute abdominal pain. Although rare, atraumatic spleen rupture (ASR) has been reported. It is not usually considered in the differential diagnosis of acute abdomen so often missed in emergency leading to high morbidity and mortality. We present the case of a 38-year-old male who presented with fever and acute abdominal pain, had atraumatic splenic rupture which was diagnosed early resulting in better outcome of patient.

P-O12 Atraumatic Splenic Rupture Secondary to Concurrent Cytomegalovirus and Epstein Barr Virus Infection

Abstract Background Infectious Mononucleosis (IM) is a common viral illness among adolescents and young adults. While most cases are self-limiting, a small number of patient can develop life threatening complications, such as atraumatic splenic rupture (ASR). This is a rare but serious sequelae, and the commonest cause of associated mortality. While Epstein Barr Virus is commonly associated with IM, concurrent infection of cytomegalovirus (CMV) and EBV is rarely reported. Both infections are associated with splenomegaly, however this is usually mild and very rarely results in ASR. Methods We present the case of an immunocompetent nineteen year old male who underwent emergency splenectomy for ASR secondary to concurrent EBV and CMV infection. He presented to the Emergency Department with a five hour history of severe, sudden onset left upper quadrant pain preceded by coughing fit. He reported a one year history of incidental splenomegaly and recent positive monospot test in community. Computerised tomography (CT) of abdomen and pelvis confirmed splenic rupture with large haemo-peritoneum and large sub-capsular haematoma. He was haemodynamically unstable and underwent laparotomy and splenectomy. Results Intraoperative findings included two litres of intraperitoneal blood and large spleen with sub-capsular haematoma; approximately seventeen centimetre diameter and weighed nine hundred and seventy grams. Pathology showed features of non-specific lymphoid hyperplasia. Serum virology confirmed high levels of CMV on polymerase chain reaction with low levels of EBV detected. Virology screening was incidentally repeated post discharge and at this time was consistent acute EBV infection. No alternative cause for splenic rupture or pre-existing splenomegaly has been identified. Conclusions The serology results in this case confirm acute CMV infection with most likely concurrent EBV infection. While we cannot confidently identify which virus caused splenic rupture in this case, ASR is a life threatening condition and an important differential in patients presenting with sudden onset LUQ pain and shock. Splenectomy remains the treatment of choice in haemodynamically unstable patients.

Atraumatic Splenic Rupture is a Rare Complication of Acute Myeloid Leukemia: A Case Report and Literature Review

Introduction: Atraumatic Splenic Rupture (ASR) is a rare but life-threatening clinicopathological phenomenon with limited information on patient features, occurrence, or etiology. Case presentation: A 48-year-old man with no history of the underlying disease presented to the emergency department with abdominal pain. He was admitted with leukocytosis 145x103/µl, hemoglobin 6.4 g/dl, and platelets 15x103/µl, ESR 89mm/h, D-Dimer 1043ng/FEU ml. Sputum test (PCR) ruled out SARS-CoV-2 infection. Due to peripheral blood smear and bone marrow aspiration/biopsy, AML was diagnosed for the patient. On the third day of hospitalization, the patient's abdominal pain intensifies. Ultrasound revealed medium free fluid inside the abdomen and pelvis. The patient was transferred to the operating room to undergo an emergency laparotomy. There was a large hematoma in the spleen with a rupture in its posterior surface. Splenectomy was performed. The histopathological study of the spleen showed leukemic involvement, capsular ruptures, and subcapsular hematomas. Discussion: ASR is an uncommon and lethal complication that is seen in infectious diseases (mainly mononucleosis) and hematological diseases (mainly malignant homeopathies) in more than half of cases. Mortality is approximately around 20%. Some deaths occur before the diagnosis is confirmed, while others occur after surgery, as a result of delayed management and poor patient status. Conclusion: ASR can occur for a variety of reasons, including non-traumatic or idiopathic factors. In the absence of significant trauma, emergency physicians should be aware that splenic rupture can occur. ASR is more likely to present with symptoms similar to the underlying disease.