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Atraumatic splenic rupture in a peritoneal dialysis patient
Chiharu Kinoshita1, Pham Nguyen Quy2, Masanori Honda3
1Department of Nephrology, Kyoto Min-iren Chuo Hospital Japan, 16-1 Nishinokyo Kasuga-cho Nakagyou-ku, Kyoto, 604-8453, Japan. kinochi3117@gmail.com.
CEN Case Reports
|July 1, 2018
Summary
Atraumatic splenic rupture (ASR) is rare, but this case highlights a potential complication in patients on peritoneal dialysis. Prompt diagnosis using CT scans and fluid analysis is crucial for effective treatment.
Area of Science:
- Nephrology
- Gastroenterology
- Radiology
Background:
- Splenic hemorrhage is typically associated with abdominal trauma.
- Atraumatic splenic rupture (ASR) is uncommon, often linked to splenic pathology like tumors or infections.
Observation:
- A 58-year-old man on PD for nephrotic syndrome presented with abdominal pain, nausea, and bloody dialysate.
- Computed tomography (CT) revealed a high-density area around the spleen and catheter malposition. Laparoscopy confirmed significant hemoperitoneum.
- Laboratory findings included severe anemia (hemoglobin 4.3 g/dL).
Findings:
- The patient was diagnosed with atraumatic splenic bleeding, potentially related to the spleen itself or catheter-induced trauma due to malposition.
- Conservative management with bed rest and blood transfusion led to improvement, allowing continuation of PD.
Implications:
- ASR requires a high index of suspicion for timely diagnosis, especially in PD patients presenting with concerning symptoms.
- CT scanning and peritoneal fluid analysis are crucial diagnostic tools.
- Prompt diagnosis and intervention are essential for managing ASR and improving patient outcomes.
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