Spontaneous splenic rupture

Abstract

Spontaneous splenic rupture is a rare entity usually associated with hematotogical, infectious, neoplastic, thrombolytic, or connective tissue diseases. We present a case of spontaneous splenic rupture which occurred in a 76 year-old-man who admitted to our department complaining of sudden onset of pain in the left upper abdomen. The patient was suffered by myeloproliferative syndrome since 4 years; and was unable to remember any trauma in the abdomen. On examination the spleen and the liver were palpable far below the costal margin, and a diffuse tenderness was noted in the epigastrium and left hypochondrium. After ultrasonography showed a moderate amount of free intra-abdominal liquid, and signs of hypovolaimia occurred, the patient was urgently taken to the operation room. At surgery, there was intra-abdominal bleeding, an enlarged spleen measuring almost double its normal size was found and two linear ruptures were noted at its diaphragmatic side (grade II). Splenectomy was successfully performed and the post operative period was uneventful. We discuss the clinical features, the diagnosis, and the treatment of spontaneous splenic rupture and present a literature review of differential diagnosis.