Splenic rupture, beyond and behind: a histological, morphometric and follow-up study of 254 cases

Population-based data regarding splenic rupture causes are sparse. To systematically characterize histology and morphometry of splenic rupture, we performed a retrospective clinicopathological study of 254 patients.

Our electronic data base was reviewed and all splenic rupture cases were morphologically, morphometrically and, where needed, molecularly analyzed. Clinical and follow-up data were gained by reviewing patient charts. A formula to calculate splenic volume based on size was established and results were compared to the actual volumes.

Ruptured spleens presented 0.1% of all gross surgical pathology specimens. Nearly 90% were due to trauma and approximately 10% were pathologic, being associated with underlying diseases (5% with unexpected diseases) such as splenic angiomas, granulomatous diseases, infarctions, hepatopathies, cysts, hemorrhagic diatheses, hematological neoplasms, metastatic carcinoma and collagenosis. Men were more often affected than women. Morphometric analysis showed distinct splenic weights, volumes and capsule thicknesses with respect to the different rupture causes. Pathological ruptures were predominantly observed in elderly, male patients with larger spleens.

Splenic rupture is due to an often unexpected underlying disease in approximately 10% of the cases. This should be kept in mind when dealing with susceptible patient groups.