If these results indicate splenic rupture, urgent abdominal surgery is needed to determine the source of the bleeding. An ultrasound scan is the most sensitive diagnostic method for injuries to the abdomen, although a normal scan may not rule out splenic rupture. In people who are hemodynamically stable, a CT scan is typically used to help determine the grade of injury.
In the emergency trauma setting, an ultrasound scan is performed while other monitoring and management continue uninterrupted. This scan is done according to the focused assessment with sonography for trauma FAST protocol, which forms part of the advanced trauma life support ATLS protocol developed by the American College of Surgeons.
A FAST ultrasound enables clinicians to scan for fluid in four areas of the abdomen, including the space around the spleen. The doctor draws fluid from the abdominal cavity. Nowadays, this is rarely performed.
A ruptured spleen is often identified by a CT scan. In some cases, such as where a patient has kidney stones or is allergic to the contrast substance used in a CT scan, a stable individual with a suspected ruptured spleen may undergo an MRI scan.
This can also show problems with the soft tissues of the body. Splenic injury is classified by severity, taking into account the level of laceration, injury to the veins and arteries, and clotting. The American Association for the Surgery of Trauma grading system for spleen injury is as follows:. The grading of a ruptured spleen helps doctors determine whether surgical or non-operative management is indicated for treatment.
Gaucher's disease is a inherited disease that results in a build up of lipids. Symptoms and outlook vary widely. It normally affects the spleen first. An aneurysm is a weakening and bulging of an artery wall. Many have no symptoms and are not dangerous. However, at their most severe, aneurysms can….
Whiplash is a series of neck injuries that occur as a result of the sudden distortion of the neck, often due to being struck from behind in an…. In this article, we discuss the spleen. We will explain what the spleen does, the types of cells involved, and what happens when it goes wrong. What are the different types of bleeding, and how can a person treat them? Read on to learn more. Everything you need to know about ruptured spleen. Medically reviewed by Andrew Gonzalez, M.
Symptoms Treatment Recovery Complications Causes Diagnosis Stages The spleen is an organ located in the left-upper quarter of the abdomen, beneath the ribs. Share on Pinterest Pain in the upper abdomen can be a sign of a ruptured spleen. Share on Pinterest A person should not return to full-intensity exercise until around 3 months after treatment.
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Related Coverage. Metrics details. Cases of non-traumatic splenic rupture are rare and entails a potentially grave medical outcome. Hence, it is important to consider the differential diagnosis of a non-traumatic splenic rupture in patients with acute or insidious abdominal pain. In this article, we attempt to highlight the features of a rare cause of splenic rupture that might serve as a future reference point for the detection of similar cases during routine clinical practice.
A year-old man presented with 1 week history of left hypochondriac pain associated with abdominal distention. There was no history of preceding trauma or fever. Clinical examination revealed signs of tachycardia, pallor and splenomegaly. He had no evidence of peripheral stigmata of chronic liver disease. In addition, haematological investigation showed anemia with leucocytosis and raised levels of lactate dehydrogenase enzyme.
However, peripheral blood film revealed no evidence of any blast or atypical cells. In view of these findings, imaging via ultrasound and computed tomography of the abdomen was performed. The results of these imaging tests showed splenic collections that was suggestive of splenic rupture and hematoma. Patient underwent emergency splenectomy and the histopathological report confirmed the diagnosis as DLBCL. The occurrence of true spontaneous splenic rupture is uncommon.
In a recent systematic review of cases of splenic rupture, only 84 cases were secondary to hematological malignancy. Acute leukemia and non-Hodgkin lymphoma were the most frequent causes of splenic rupture, followed by chronic and acute myelogeneous leukemias. The morbidity and mortality rate is greatly increased when there is a delay in the diagnosis and intervention of splenic rupture cases. Hence, there should be an increased awareness amongst both physicians and surgeons that a non-traumatic splenic rupture could be the first clinical presentation of a DLBCL.
Peer Review reports. Non-traumatic splenic rupture is a rare clinical presentation with potentially grave medical outcome. Owing to its elusive nature, the recognition of a non-traumatic splenic rupture requires a high index of clinical suspicion [ 1 , 2 ].
Few incidences of true spontaneous rupture of spleen have been reported in the literature despite its rarity [ 3 , 4 ]. Conversely, non-traumatic splenic rupture is common and often related to also known as pathological rupture a diseased spleen. Common causes of non traumatic splenic rupture include myeloproliferative diseases, vasculitis and infections such as malaria or infectious mononucleosis.
However, diffuse large B-cell lymphoma DLBCL remains an obscure cause of splenic rupture that requires unique attention [ 4 , 5 ]. A 40 year old Malay male was seen at the emergency department with 1 week history of left hypochondriac pain with concurrent abdominal distention. He also complained of loss of appetite and feeling lethargic for 1 month duration. He had no fever, nausea, vomiting, changes in bowel habits or any history of bleeding diathesis.
There was no history of trauma. Neither there were any significant past medical history nor family history of malignancy. He was an active smoker for 20 years but denied any alcohol consumption or substance abuse. Patient appeared pale. Abdominal examination revealed enlarged, non-tender liver and spleen. There was no ascites or peripheral lymphadenopathy. Cardiovascular and respiratory examinations were otherwise unremarkable.
Haematological investigation revealed a low haemoglobin level at 6. The patient had a white cell count WCC of Differential WCC showed a predominant neutrophil count of Peripheral blood film revealed leucocytosis with neutrophilia with no evidence of blast cells or atypical lymphocytes. Patient was reluctant to undergo a bone marrow aspiration and trephine biopsy.
Abdominal ultrasonography demonstrated a large splenic collection. There were no intra abdominal or pelvic lymph nodes enlargement. Based on computed tomography findings, a preliminary diagnosis of spontaneous splenic rupture was made.
A surgical consult was obtained and an explorative laparotomy was performed on the patient. Intra operative findings showed a ruptured spleen with extensive adhesions to the omentum. No intra peritoneal lymph nodes enlargement were found. Splenectomy was then performed and subsequently, the patient was transferred to intensive care unit for close observation. From a histological perspective, the gross appearance of the obtained specimen revealed an enlarged spleen with irregular outer surfaces.
A cut section of the spleen showed a firm, cream coloured layer occupying almost entire spleen with large area of necrosis with splenic infarcts. There as minimal amount of normal looking parenchyma tissues at the peripheral aspect of the specimen. Further histological examination revealed a diffuse infiltration of malignant lymphoid cells, which exhibited irregular nuclear membrane with vesicular nuclear chromatin and prominent nucleoli.
The adjacent splenic parenchyma showed a congested and expanded red pulp with infiltration by atypical lymphoid cells [Fig. Thirteen days later, the patient was discharged with prophylactic meningococcal, pneumococcal and influenza vaccinations. He was referred to the haemato-oncologist outpatient clinic at a tertiary care centre for post - operative chemotherapy. Unfortunately, the patient did not turn up for subsequent follow ups, rendering it difficult to further document any information with regards to treatment response in this report.
There is a variation in symptom manifestation in patients with splenic rupture. The presence of abdominal pain in splenic rupture has been frequently reported [ 8 ].
Abdominal pain, tenderness in the epigastrium and discomfort in the left upper quadrant may be seen in patients who has experienced minor injury [ 9 ]. In larger splenic injuries, signs of hypovolemic shock was a common presentation [ 10 ].
The clinical signs of shock include tachycardia, rapid breathing, paleness, reduced capillary filling time and hypotension [ 10 ]. In the absence of trauma, clinicians should exercise a high index of suspicion to rule out other rare causes of splenic rupture. Bassler et al.
The aetiology of atraumatic splenic ruptures were listed in the decreasing order of prevalence as follows: infectious mainly malaria and infectious mononucleosis , medical procedures related mostly related to colonoscopy , haematological commonly non-Hodgkin Lymphoma and Acute Lymphoblastic Leukemia , neoplastic disease, medication related anti coagulation and thrombolytics , pregnancy-related and others.
Majority of these cases had a haematological origin NHL was reported as the cause for splenic rupture in 6. Based on this systematic review, compounded with other evidence [ 4 , 8 , 12 ], we identified only a handful of splenic rupture that can be attributed to diffuse large B-cell lymphoma [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ].
Other subtypes of non-Hodgkin lymphoma splenic T cell lymphoma, blastic variant Mantle cell lymphoma, Mantle cell lymphoma, anaplastic large cell lymphoma, unspecified malignant lymphoma and hepatosplenic gamma delta T cell lymphoma were reported with similar prevalence rates [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ].
Cases of diffuse histiocytic lymphoma, follicular low grade lymphoma, malignant lymphomonocytic B-cell lymphoma and diffuse histiocytic lymphoma were reported infrequently [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ].
In another review by P. Renzulli et al. The six major aetiological groups were classified as follows: neoplastic The review also noted that the neoplastic subgroup was significantly associated with increased mortality rates [ 12 , 34 ].
Non-traumatic splenic rupture secondary to haematological malignancies is still widely considered as an uncommon occurence [ 35 ]. Nonetheless, limited case reports advocate early recognition and intervention of this rare cause of splenic rupture [ 8 , 36 , 37 ]. In addition, several authors have attributed the low index of suspicion as a major reason for the delayed diagnosis of similar cases of spontaneous splenic rupture secondary to NHL [ 36 , 38 , 39 ].
To that effect, our case report presents rare descriptions where splenic rupture was detected as the first manifestation of a DLBCL [ 11 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 40 , 41 , 42 ]. Merck Manual Professional Version.
Hoffman R, et al. Infectious mononucleosis and other Epstein-Barr virus-associated diseases. In: Hematology: Basic Principles and Practice. Elsevier; Accessed April 12, Liu J, et al. Diagnosis and treatment of atraumatic splenic rupture: Experience of 8 cases. Gastroenterology Research and Practice. Doherty GM, ed. McGraw-Hill; Diercks DB, et al. Initial evaluation and management of blunt abdominal trauma in adults.
Related Ruptured spleen.
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