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Complicated malaria and a covert ruptured spleen: a case report
Peter Waweru1, Jana Macleod2, Anthony Gikonyo3
1Department of Surgery, The Karen Hospital, Nairobi, Kenya pwaweru09@gmail.com.
Journal of Surgical Case Reports
|November 15, 2014
Summary
Spontaneous splenic rupture is a rare complication of severe malaria. This case highlights a challenging diagnosis where initial imaging was inconclusive, necessitating surgical intervention.
Area of Science:
- Tropical Medicine
- Gastroenterology
- Emergency Medicine
Background:
- Spontaneous splenic rupture is an uncommon but serious complication of malaria, particularly in tropical regions.
- Pathophysiology involves subcapsular hematoma formation, leading to hemoperitoneum.
- Computed tomography (CT) scans typically detect splenic injury in 95% of cases.
Observation:
- A 38-year-old male with severe malaria presented with fever, chills, and abdominal pain.
- Abdominal CT scan did not reveal splenic parenchymal injury or contrast extravasation.
- Conservative management failed to resolve the bleeding.
Findings:
- Exploratory laparotomy confirmed the spleen as the source of bleeding.
- Splenectomy was required due to persistent hemorrhage.
- This case underscores diagnostic challenges in atypical presentations of malaria complications.
Implications:
- Highlights the importance of considering splenic rupture in severe malaria, even with negative initial imaging.
- Emphasizes the need for prompt surgical intervention in cases of suspected hemoperitoneum refractory to conservative management.
- Contributes to understanding rare but critical presentations of malaria in clinical practice.
