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Spontaneous rupture of a normal spleen
1Department of General Surgery, Wrexham Maelor Hospital, Wrexham, Clwyd.
International Journal of Clinical Practice
|May 2, 2003
Summary
A patient with a history of pancreatico-renal transplant developed shock due to spontaneous splenic rupture. This rare complication highlights the importance of monitoring immunosuppressed patients for unusual vascular events.
Area of Science:
- Nephrology
- Transplantation
- Vascular Surgery
Background:
- A 45-year-old woman with end-stage renal disease due to type I diabetes underwent a pancreatico-renal transplant.
- She was on immunosuppressive therapy and presented with a gangrenous toe.
Observation:
- The patient developed shock, characterized by hypotension and tachycardia, following epidural catheter placement for pain management.
- Initial investigations revealed severe anemia (Hb 5.0 g/dl) and free fluid in the peritoneal cavity on ultrasound.
Findings:
- Emergency laparotomy confirmed massive hemoperitoneum secondary to a spontaneous splenic rupture.
- Histological examination revealed capsular defects and subcapsular hemorrhage, with no intrinsic splenic pathology.
Implications:
- Spontaneous splenic rupture is a rare but life-threatening complication in immunosuppressed transplant recipients.
- This case underscores the need for vigilance in diagnosing unusual causes of shock in this patient population.
- Further research into the mechanisms of splenic complications post-transplant may be warranted.