Rupture of the spleen in infective endocarditis

Area of Science:

• Medicine
• Infectious Diseases
• Surgery

Background:

• Infective endocarditis (IE) is a serious infection of the heart's inner lining.
• Splenic complications, though rare, can arise from IE.
• Delayed spontaneous splenic rupture is a critical, albeit uncommon, manifestation.

Observation:

• A case presented with delayed spontaneous splenic rupture secondary to infective endocarditis.
• Literature review identified 20 prior cases (pre-1973).
• Common presentation included left upper quadrant pain, peritoneal signs, and cardiovascular collapse.

Findings:

• Abdominal paracentesis frequently revealed free blood or pus.
• Pathological mechanisms include mycotic aneurysm rupture, splenic abscess, or suppurating intrasplenic vessel rupture.
• Subcapsular hematoma and delayed capsular tear were noted.

Implications:

• Early recognition of splenic rupture in IE patients is vital.
• Aggressive management, including fluid resuscitation and emergency splenectomy, can be life-saving.
• Understanding the underlying pathophysiology aids in clinical management.