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Spontaneous splenic rupture: A rare complication of acute myeloid leukemia. Report of a case
Amal Hajri1,2, Karim Yaqine1,2, Salaheddine El Massi1,2
1Departement of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco.
Introduction:
Spontaneous rupture of the spleen (SPR) is a rare and severe affection, difficult to diagnose, with multiple causes such as: Infectious and hematologic affections which represent more than half of the cases. Among this subset of patients, acute myeloid leukemia is one of the causes.
Presentation Of Case:
A 48-year-old man undergoing chemotherapy for acute myeloid leukemia presented with acute intense abdominal pain. Computed tomography showed Abdominal CT scan showed a splenic rupture with abundant hemoperitoneum and bilateral pleural effusion. The patient presented hemodynamic instability and was immediately operated, splenectomy were performed.
Discussion:
Spontaneous rupture of the spleen usually presents as a severe abdominal syndrome, which may accompany non-specific symptoms.Two signs are suggestive of splenic rupture: Kehr's sign (left diaphragmatic irritation resulting in referred pain to the left shoulder) and Balance's sign (palpable tender mass in the left upper quadrant. Diagnostic methods of choice are computed tomography andultrasound. The prognosis is depending on the quality of care and the nature of the etiology. Splenectomy remains the cornerstone of the treatment of splenic rupture. It is important to include splenic rupture as a differential diagnosis for acute abdominal pain, especially in patients with hematologic malignancy, since early recognition and treatment increase patient survival and improve the prognosis.
Conclusion:
Even if spontaneous splenic rupture is rare, every clinician should have in mind the reflex to think of it, especially in patients with hematologic malignancies.
Insights
Spontaneous splenic rupture is a rare but serious condition, often linked to hematologic malignancies like acute myeloid leukemia. Early diagnosis and splenectomy are crucial for improving patient outcomes.
Area of Science:
- Hematology
- Gastroenterology
- Emergency Medicine
Background:
- Spontaneous splenic rupture (SPR) is a rare, severe condition with diverse causes, frequently associated with infectious and hematologic disorders.
- Acute myeloid leukemia (AML) is identified as a significant underlying cause of SPR in patients with hematologic malignancies.
Observation:
- A 48-year-old male undergoing chemotherapy for AML presented with acute abdominal pain, hemodynamic instability, and signs of splenic rupture on CT scan.
- CT imaging revealed splenic rupture with hemoperitoneum and bilateral pleural effusion, necessitating immediate surgical intervention.
Findings:
- Splenic rupture, particularly in the context of hematologic malignancy, can manifest with severe abdominal symptoms.
- Diagnostic tools such as CT and ultrasound are essential for identifying splenic rupture, while Kehr's and Balance's signs may be suggestive.
- Splenectomy is the primary treatment for splenic rupture, with prognosis dependent on care quality and etiology.
Implications:
- Clinicians must consider spontaneous splenic rupture in the differential diagnosis of acute abdominal pain, especially in patients with hematologic malignancies.
- Prompt recognition and management of splenic rupture significantly enhance patient survival rates and improve overall prognosis.
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