Splenic rupture in patients with hematologic malignancies

Area of Science:

• Oncology
• Hematology
• Surgical Pathology

Background:

• Pathologic splenic rupture is a rare complication in patients with hematologic malignancies.
• It most commonly occurs in acute leukemia but is also seen in chronic leukemias and lymphoma.

Observation:

• Abdominal pain is a common symptom, often misdiagnosed as other acute abdominal conditions.
• Key clinical signs include hypotension (66%), fever (74%), and tachycardia (75%).
• Kehr's sign (referred shoulder pain) was present in only 17% of patients.

Findings:

• Paracentesis was the most effective diagnostic procedure for intraabdominal hemorrhage.
• Preoperative diagnosis of splenic rupture was achieved in only 10 of 53 reviewed cases.
• While 52% of patients underwent laparotomy, 48% died without surgical intervention.

Implications:

• Surgical intervention is the most critical factor for survival in patients with pathologic splenic rupture.
• Survival rates were 78% for operated patients versus 38% overall.
• No correlation was found between malignancy type, treatment, blood counts, or spleen size and survival outcomes.