CASE 871: NON-TRAUMATIC SPLENIC RUPTURE, Dr PHAN THANH HẢI, Dr NGUYỄN XUÂN HOÀNG, MEDIC MEDICAL CENTER, HCMC, VIETNAM

 A 60 year-old diabetic man with cough and LUQ pain for 10 days. He denied any trauma in history.

Going to Medic Center in pain and anemia; POCUS in emergency detected free fluid in abdomen and hyperechogenic mass around the spleen, and left pleural effusion.

Lab data noted anemia and infectious syndrome of a diabetic patient.

MSCT confirmed a splenic rupture and free fluid in abdomen and pleural effusion both two sides.

A splenectomy was done and the patient remains well.

Coughing is a rare cause induced a non-traumatic splenic rupture besides jogging, squash, cycling and electroconvulsive therapy.

References:

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 COMMENTS 

Background NSR is a rare condition in emergency surgery. NSR may be seen along with different diseases, such as malaria, infections, malignancies, metabolic disorders, as well as vascular and hematological diseases. Also, spontaneous rupture of the spleen may be observed. Absence history of a trauma may not remind a rupture needs a high index of suspicion for diagnosis in spleen.

Research frontiers The criteria for NSR were first described by Orloff et al in 1958 and our patients with NSR were in accordance with these criteria.

Innovations and breakthroughs Our study emphasized that rapid diagnosis, aggressive resuscitation, and surgical intervention are important for successful outcome in patients with NSR. If the patient with intra-abdominal hemorrhage has no associated trauma, splenic rupture should be considered.

Applications NSR may be shown in particular in endemic regions of malaria, hematological malignancies, and spontaneous and chronic renal failure.

Peer review In this study, NSR was presented with different diseases. Diagnosis of NSR, using ultrasonography or CT, and paracentesis, is difficult. Splenectomy may lead to a successful outcome in patients with NSR.

2/  The diagnosis of atraumatic splenic rupture (ASR) can be made with the Orloff and Peskin criteria, which states that ASR can be diagnosed when the following four criteria are met: 1) thorough history reveals no antecedent trauma; 2) no evidence of disease in organs other than the spleen that can cause rupture; 3) no perisplenic adhesions or scarring consistent with trauma or past rupture; and 4) normal spleen on gross and histological examination. 

From

. 2014 Nov 30;8:396. doi: 10.1186/1752-1947-8-396: Possible infectious causes of spontaneous splenic rupture: a case report Grace Y Lam ¹, Adrienne K Chan ^2,3, Jeff E Powis ^2,✉

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