Abstract
Bu çalışmada, atravmatik dalak rüptürü (ASR) olan hastalardaki klinik deneyimimizi paylaşmayı amaçlıyoruz. Tüm hastaların kayıtları Ocak 2015'ten Mayıs 2024'e kadar retrospektif olarak incelendi. ASR tanısı konulan 8 hastamız vardı.. Hastaların %62.5'i (n=5) kadındı. Ortanca yaş 52.5 (37-72) yıldı. Üç hastada malignite öyküsü, iki hastada hematolojik hastalık ve üç hastada otoimmün hastalık vardı. İki hasta daha önce karın ameliyatı geçirmişti. İki hastada oral antikoagülan kullanma öyküsü vardı. Semptomların başlangıcı ortanca 16 (1-168) saatti. Üç hastaya Epstein-Barr Virüsü ve Sitomegalovirüs testleri yapıldı ve tümünde sonuç negatifti. Üç hastada bilgisayarlı tomografi ile splenomegali tespit edildi. Bir hastada splenektomiye ek olarak distal pankreatektomi yapılırken, bir diğer hastaya distal pankreatektomi, gastrik wedge rezeksiyon ve packing yapıldı. Operasyon süresi ortanca 122.5 (60-210) dakikaydı. Ortanca hastanede kalış süresi 8.5 (1-41) gündü. Patolojik sonuçlar bir hastada adenokarsinom metastazı (endometriyal kanser nedeniyle) ve bir hastada nekrotizan granülomatöz inflamasyondu (abdominal tüberküloz nedeniyle). Ameliyat sonrası erken komplikasyon sadece bir hastada pankreas fistülü olarak görüldü. Üç hastada mortalite görüldü. Bir hasta postoperatif ikinci saatte hipovolemik şoktan, bir diğeri sepsis nedeniyle ve üçüncüsü subaraknoid kanama nedeniyle öldü. Klinik olarak belirsiz sunumuna rağmen, travma öyküsü olmayan ancak hipovolemik şok, akut karın veya etiyolojisi bilinmeyen karın ağrısı ile gelen hastalarda spontan dalak rüptürü tanısı düşünülmelidir.
References
- 1. Renzulli P, Hostettler A, Schoepfer AM, Gloor B, Candinas D. Systematic review of atraumatic splenic rupture. J Br Surg. 2009;96:1114–21.
- 2. Kocael PC, Simsek O, Bilgin IA, Tutar O, Saribeyoglu K, Pekmezci S, et al. Characteristics of patients with spontaneous splenic rupture. Int Surg. 2014;99:714–8.
- 3. Gómez-Ramos JJ, Marín-Medina A, Lisjuan-Bracamontes J, García-Ramírez D, Gust-Parra H, Ascencio-Rodríguez MG. Adolescent with spontaneous splenic rupture as a cause of hemoperitoneum in the Emergency Department: case report and literature review. Pediatr Emerg Care. 2020;36:e737–41.
- 4. Crate ID, Payne MJ. Is the diagnosis of spontaneous rupture of a normal spleen valid? J R Army Med Corps. 1991;137:50–1.
- 5. Chapman J, Goyal A, Azevedo AM. Splenomegaly. (StatPearls Publishing, 2022)
- 6. Reinhold GW, Melonakos TK, Lyman DT. A near fatal sneeze spontaneous splenic rupture: a case report and review of the literature. Clin Pract Cases Emerg Med. 2017;1:190-3.
- 7. Odabaş EN, Topçuoğlu H, Aydoğan T, Özer V, Karaca Y. A rare cause of abdominal pain: Spontaneous rupture of the spleen. J Surg Med. 2021;5:389–91.
- 8. Xu H, Lu JP. Spontaneous rupture of the spleen at full term during pregnancy: a case report. J Int Med Res. 2023;51:1-5.
- 9. Fugl A, Andersen CL. Epstein-Barr virus and its association with disease - a review of relevance to general practice. BMC Fam Pract. 2019;20:1-8.
- 10. Maria V, Saad AM, Fardellas I. Spontaneous Spleen Rupture in a Teenager: An Uncommon Cause of Acute Abdomen. Case Rep Med. 2013;2013:1–3.
- 11. Marcos-Ramírez ER, Treviño-García LA, Téllez-Aguilera A, Molina-Ayala M, Flores-Gutiérrez JP, Salinas-Domínguez R, et al. Spontaneous splenic rupture, an unusual presentation of tuberculosis. Cir Cir. 2021;89:1–5.
- 12. Weinberg Y, Feldman A, Jakobson DJ, Mishal J. Spontaneous Pathologic Splenic Rupture in a Patient with Plasmodium falciparum Infection, First Case Reported in Israel. Infect Dis Rep. 2020;12:121–6.
- 13. Wolthuis DF, Bosboom RW, Hassing RJ. Spontaneous splenic rupture in an ill returned traveller. Eur J Case Rep Intern Med. 2020;7:1-3.
- 14. Hwang HP, Kim KM, Han H, Hwang JH. Spontaneous splenic rupture associated with scrub typhus: a case report. Infect Dis Poverty. 2024 Jan 22;13:1-7.
- 15. Deleuze C, Rasmont C, Ivanov T, Brassart N, Ghaddab M, Romero Stoca L, et al. A case of splenic rupture a week after appendectomy. J Surg Case Rep. 2021;12:1-3.
- 16. Sandal M, Hussein BA, Buti F, Al Marzouqi O, Khammas A. Spontaneous splenic rupture two weeks after sleeve gastrectomy. Obes Surg. 2020;30:3226–8.
- 17. Jain D, Lee B, Rajala M. Atraumatic splenic hemorrhage as a rare complication of pancreatitis: case report and literature review. Clin Endosc. 2020;53:311–20.
- 18. Gregory R. A Near Fatal Sneeze Spontaneous Splenic Rupture: A Case Report and Review of the Literature. 2017;1:190-3.
Abstract
In this present study, we aim to share our clinical experience in patients with atraumatic splenic rupture (ASR). The records of all patients were reviewed from January 2015 to May 2024, retrospectively. We had 8 patients diagnosed with ASR. Of the patients 62.5% (n=5) were female. The median age was 52.5 (37-72) years. Three patients had a history of malignancy, two had hematologic disease, and three had autoimmune disease.Two patients had previously undergone abdominal surgery.Two patients had a history of oral anticoagulant use.The median onset of symptoms was 16 (1-168) hours. Splenomegaly was detected in three patients via computed tomography. In one patient, a distal pancreatectomy was performed in addition to splenectomy, while for another patient, distal pancreatectomy, gastric wedge resection, and packing were performed. The median operation time was 122.5 (60-210) min. The median hospital stay was 8.5 (1-41) days. Pathological results showed adenocarcinoma metastasis in one patient (due to endometrial cancer), and necrotising granulomatous inflammation in one patient (due to abdominal tuberculosis). Early postoperative complication was seen only one patient as pancreatic fistula. Mortality occurred in three patients. One patient died in the second postoperative hour from hypovolemic shock, another from sepsis, and the third from a subarachnoid hemorrhage. Despite its clinically vague presentation,the diagnosis of spontaneous splenic rupture should be considered in patients with no history of trauma but who present with hypovolemic shock,acute abdomen or abdominal pain of unknown etiology.
Keywords
acute abdomen spontaneus spleen ruptur nontraumatic splenic damage intraabdominal hemorrhage
References
- 1. Renzulli P, Hostettler A, Schoepfer AM, Gloor B, Candinas D. Systematic review of atraumatic splenic rupture. J Br Surg. 2009;96:1114–21.
- 2. Kocael PC, Simsek O, Bilgin IA, Tutar O, Saribeyoglu K, Pekmezci S, et al. Characteristics of patients with spontaneous splenic rupture. Int Surg. 2014;99:714–8.
- 3. Gómez-Ramos JJ, Marín-Medina A, Lisjuan-Bracamontes J, García-Ramírez D, Gust-Parra H, Ascencio-Rodríguez MG. Adolescent with spontaneous splenic rupture as a cause of hemoperitoneum in the Emergency Department: case report and literature review. Pediatr Emerg Care. 2020;36:e737–41.
- 4. Crate ID, Payne MJ. Is the diagnosis of spontaneous rupture of a normal spleen valid? J R Army Med Corps. 1991;137:50–1.
- 5. Chapman J, Goyal A, Azevedo AM. Splenomegaly. (StatPearls Publishing, 2022)
- 6. Reinhold GW, Melonakos TK, Lyman DT. A near fatal sneeze spontaneous splenic rupture: a case report and review of the literature. Clin Pract Cases Emerg Med. 2017;1:190-3.
- 7. Odabaş EN, Topçuoğlu H, Aydoğan T, Özer V, Karaca Y. A rare cause of abdominal pain: Spontaneous rupture of the spleen. J Surg Med. 2021;5:389–91.
- 8. Xu H, Lu JP. Spontaneous rupture of the spleen at full term during pregnancy: a case report. J Int Med Res. 2023;51:1-5.
- 9. Fugl A, Andersen CL. Epstein-Barr virus and its association with disease - a review of relevance to general practice. BMC Fam Pract. 2019;20:1-8.
- 10. Maria V, Saad AM, Fardellas I. Spontaneous Spleen Rupture in a Teenager: An Uncommon Cause of Acute Abdomen. Case Rep Med. 2013;2013:1–3.
- 11. Marcos-Ramírez ER, Treviño-García LA, Téllez-Aguilera A, Molina-Ayala M, Flores-Gutiérrez JP, Salinas-Domínguez R, et al. Spontaneous splenic rupture, an unusual presentation of tuberculosis. Cir Cir. 2021;89:1–5.
- 12. Weinberg Y, Feldman A, Jakobson DJ, Mishal J. Spontaneous Pathologic Splenic Rupture in a Patient with Plasmodium falciparum Infection, First Case Reported in Israel. Infect Dis Rep. 2020;12:121–6.
- 13. Wolthuis DF, Bosboom RW, Hassing RJ. Spontaneous splenic rupture in an ill returned traveller. Eur J Case Rep Intern Med. 2020;7:1-3.
- 14. Hwang HP, Kim KM, Han H, Hwang JH. Spontaneous splenic rupture associated with scrub typhus: a case report. Infect Dis Poverty. 2024 Jan 22;13:1-7.
- 15. Deleuze C, Rasmont C, Ivanov T, Brassart N, Ghaddab M, Romero Stoca L, et al. A case of splenic rupture a week after appendectomy. J Surg Case Rep. 2021;12:1-3.
- 16. Sandal M, Hussein BA, Buti F, Al Marzouqi O, Khammas A. Spontaneous splenic rupture two weeks after sleeve gastrectomy. Obes Surg. 2020;30:3226–8.
- 17. Jain D, Lee B, Rajala M. Atraumatic splenic hemorrhage as a rare complication of pancreatitis: case report and literature review. Clin Endosc. 2020;53:311–20.
- 18. Gregory R. A Near Fatal Sneeze Spontaneous Splenic Rupture: A Case Report and Review of the Literature. 2017;1:190-3.
Details
| Primary Language | English |
|---|---|
| Subjects | General Surgery |
| Journal Section | ORİJİNAL MAKALE |
| Authors | |
| Publication Date | January 17, 2025 |
| Submission Date | November 27, 2024 |
| Acceptance Date | January 6, 2025 |
| Published in Issue | Year 2025 Volume: 47 Issue: 1 |