Báez-García JJJ, Martínez-Hernández MP, Iriarte-Gallego G, Báez-Aviña JA

Language: Spanish
References: 28
Page: 538-542
PDF size: 374.31 Kb.

ABSTRACT

Background: Rupture of the spleen has been classically associated with trauma. It sometimes is a spontaneous event or may be secondary to a pathological condition of the spleen or even in a healthy spleen. Systemic amyloidosis is characterized by the extracellular deposition of amyloid proteins in one or more organs. The spleen can be affected in 41% of patients. We undertook this study to present a case of spontaneous splenic rupture secondary to amyloid infiltration of the spleen, an uncommon condition in the literature.
Clinical case: We present the case of a 46-year-old male with abdominal pain, fever, abdominal distention and tachycardia. There were peritoneal signs during physical examination and leukocytosis was reported in the laboratory tests. The patient previously received analgesics and we suspected acute appendicitis modified by medications. It was decided to perform a laparotomy, finding hemoperitoneum as a consequence of spleen rupture. We performed splenectomy with a favorable patient outcome. Histopatological study reported amyloid infiltration of the spleen.
Conclusions: In patients with abdominal pain and hypotension, we should suspect the possibility of a spontaneous splenic rupture, even without trauma or infection history. Delayed diagnosis and treatment may be fatal.

REFERENCES

1. Toubia NT, Tawk MM, Potts RM, Kinasewitz GT. Cough and spontaneous rupture of a normal spleen. Chest 2005;128:1884-1886.

2. Halkic N, Vuilleumier H, Qanadli SD. Spontaneous splenic rupture in infectious mononucleosis treated by embolization of the splenic artery. Can J Surg 2004;47:221-222.

3. Carrillo-Herranz A, Ramos-Sánchez N, Sánchez-Pérez I, Lozano- Giménez C. Rotura espontánea de bazo secundaria a mononucleosis infecciosa. An Pediatr 2003;58:191-202.

4. Bernat S, García-Boyero R, Guinot T, López F, Gozalbo T, Cañigra G. Pathologic rupture of the spleen as the initial manifestation in acute lymphoblastic leukemia. Haematologica 1998;83:760-761.

5. Choudhury J, Ghosh Uttam K, Mukhopadhyay M. Spontaneous rupture of malarial spleen. Indian Pediatr 2008;45:327-328.

6. Rovira RE, Díaz-Gómez JR, Lapuebla X, Aguar MC. Rotura espontánea de bazo en un caso de leishmaniasis visceral. Enferm Infecc Microbiol Clin 2005;23:327.

7. Tarifa-Castilla A, Salvoch-Arnedo FJ, Arín-Palacios B, Lera-Tricas JM. La imagen del mes. Rotura de aneurisma de arteria esplénica. Cir Esp 2007;81:159.

8. Cassar K, Munro A. Clinical review. Iatrogenic splenic injury. JR Coll Surg Edinb 2002;47:731-741.

9. Stupnik T, Vidmar S, Hari P. Spontaneous rupture of a normal spleen following bronchoplastic left lung lower lobectomy. Interact Cardio-Vasc Thorac Surg 2008;7:290-291.

10. Peera MA, Lang ES. Delayed diagnosis of spleen rupture following minor trauma: beware of comorbid conditions. Can J Emerg Med 2004;6:217-219.

11. Giagounidis AAN, Burk M, Meckenstock G, Koch AJ, Schneider W. Pathologic rupture of the spleen in hematologic malignancies: two additional cases. Ann Hematol 1996;73:297-302.

12. Yagmur Y, Hamdi Kara I, Aldemir M, Büyükbayram H, Tacyildiz IH, Keles C. Spontaneous rupture of malarial spleen: two case reports and review of literature. Crit Care 2000;4:309-313.

13. Ozsoy MF, Oncul O, Pekkafali Z, Pahsa A, Yenen OS. Splenic complications in malaria: report of two cases from Turkey. J Med Microbiol 2004;53:1255-1258.

14. Stephenson JT, Du Bois JJ. Nonoperative management of spontaneous splenic rupture in infectious mononucleosis: a case report and review of the literature. Pediatrics 2007;120:e432-e435.

15. Maillard N, Koenig M, Pillet S, Cuilleron M, Cathébras P. Spontaneous splenic rupture in primary cytomegalovirus infection. Presse Med 2007;36:874-877.

16. Bauer TW, Haskings GE, Armitage JO. Splenic rupture in patients with hematologic malignancies. Cancer 1981;48:2729-2733.

17. Han SM, Teng CL, Hwang GY, Chou G, Tsai CA. Primary splenic lymphoma associated with hemophagocytic lymphohistiocytosis complicated with spleen rupture. J Chin Med Assoc 2008;71:210-213.

18. Biswas S, Keddington J, McClanathan J. Large B-cell lymphoma presenting as acute abdominal pain and spontaneous splenic rupture: a case report and review of relevant literature. WJ Emerg Surg 2006;1:35. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1712221/

19. Seyama Y, Tanaka N, Suzuki Y, Nagai M, Furuya T, Nomura Y, et al. Spontaneous rupture of splenic hamartoma in a patient with hepatitis C virus-related cirrhosis and portal hypertension: a case report and review of the literature. World J Gastroenterol 2006;12:2133-2135.

20. Domínguez-Jiménez GL, Cárdenas-Laison LE, Mijares-García JM, Ramírez-Solís ME, Reyes-Pérez E, Villanueva-Egan A. Ruptura espontánea del bazo asociada a linfangioma esplénico de elementos pequeños. Informe de un paciente. Cir Gen 2002;24:57-60.

21. Powsner RA, Simms RW, Chudnovsky A, Lee VW, Skinner M. Scintigraphic functional hyposplenism in amyloidosis. J Nucl Med 1998;39:221-223.

22. Fernández-Sobrino G, Cosme-Reyes C, Belmonte-Montes C. Ruptura esplénica espontánea idiopática. Reporte de un caso y revisión de la literatura. Rev Sanid Milit Mex 2002;56:135-138.

23. Atkinson E. Death from idiopathic rupture of the spleen. Br Med J 1874;2:403–404.

24. Lemon M, Dorsch M, Street K, Cohen R, Hale P. Splenic ruptures after vomiting. J R Soc Med 2001;94:527-528.

25. MacKenzie KA, Soiza RL. Spontaneous splenic rupture mimicking pneumonia: a case report. Cases J 2008;35:1-3.

26. Eowenfels AB. Kehr’s sign: a neglected aid in rupture of the spleen. N Engl J Med 1966;274:1019.

27. Espinosa-González R. Traumatismo esplénico. Santiago, Chile: Pontificia Universidad Católica de Chile, Facultad de Medicina; 2003. Disponible en http://www.urgenciauc.com/profesion/pdf/trauma/traumatismo_esplenico.pdf

28. Bandiera G, Poulin E. Unusual case of acute onset abdominal pain: uses and limitations of medical imaging. Can J Emerg Med 2003;5:263-267.