Cocaine-associated hemoperitoneum following atraumatic splenic rupture: a case report and literature review

Azar, Faris; Brownson, Elisha G.; Dechert, Tracey

doi:10.1186/1749-7922-8-33

Cited by 9 publications

(10 citation statements)

References 8 publications

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“…Cocaine attains high concentrations within the spleen and the associated vasoconstriction has been shown to transiently reduce splenic volume on average by 20% [ 2 ]. Splenic hemorrhage may occur from arteriolar rupture from accelerated hypertension or from infarction and subsequent hemorrhage following resolution of vasospasm [ 1 , 3 ].…”

Section: Discussionmentioning

confidence: 99%

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Cocaine-induced splenic rupture

Khan

Casaubon

Regan

et al. 2017

Journal of Surgical Case Reports

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Splenic rupture is a rare but serious complication from cocaine abuse. Given the ubiquitous prevalence of abuse and the potential for death from intraperitoneal bleeding, the prompt diagnosis and treatment of cocaine-induced disease including splenic rupture is essential. The management for splenic rupture from traumatic and atraumatic etiology has shifted from emergent laparotomy and splenectomy to non-operative approach with transcatheter splenic artery embolization. We report a 39-year-old male with a significant substance abuse history who presented with atraumatic splenic rupture. He was managed nonoperatively with adjunctive transcatheter splenic artery embolization. His post-procedure course was complicated by an intra-abdominal abscess requiring drainage via interventional radiology guided pigtail catheter placement and intravenous antibiotics. This case report is intended to raise awareness of the potentiating effects of cocaine use in this patient population and highlight questions raised during this patient's management.

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Section: Discussionmentioning

confidence: 99%

“…It blocks presynaptic sympathetic reuptake of norepinephrine (NE), causing accumulation in synaptic clefts. NE induces alpha-adrenergic stimulation and vasoconstriction which is the underlying culprit in organ damage [ 2 ]. We herein present a case of cocaine-induced splenic rupture with a review of the literature.…”

Section: Introductionmentioning

confidence: 99%

Cocaine-induced splenic rupture

Khan

Casaubon

Regan

et al. 2017

Journal of Surgical Case Reports

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“…15 Azar and colleagues reported a case of atraumatic splenic rupture and hemoperitoneum following intranasal cocaine use where the patient was managed supportively and improved. 16 There is one other report of hemoperitoneum following intravenous cocaine use, in which an exploratory laparotomy did not reveal the source of bleeding. 17 None of the cases had a splenic angiogram performed that would have better demonstrated the bleeding in the spleen.…”

Section: Discussionmentioning

confidence: 98%

Cocaine Use and Splenic Rupture: A Rare Yet Serious Association

Karthik

Gnanapandithan

2016

Clinics and Practice

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Cocaine abuse is frequent in patients visiting the emergency department. The knowledge of the cardiovascular complications of cocaine is excellent among physicians. However the awareness regarding its abdominal complications, the most important of which include gastroduodenal perforation, bowel ischemia and splenic rupture is less adequate. We report a 58-year-old with cocaine use who presents with upper abdominal pain and a rapidly worsening clinical status. He was found to have atraumatic splenic rupture causing a hemoperitoneum that was managed by intervention radiology guided splenic artery embolization. Splenic hemorrhage and rupture need timely recognition, as they are difficult to diagnose clinically and can be potentially fatal. In the encounter of patients with cocaine use who present with chest or upper abdominal pain, clinicians should consider imaging to look for splenic rupture as it is often masked or overlooked due to the complicated clinical picture.

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“…In cases of ASR associated with recent cocaine ingestion, it has been postulated that the initiating event is the development of splenic infarctions as a result of profound vasospasm. Increased vascular permeability and hypertension then result in haemorrhagic transformation and eventual capsular rupture[22]. To our knowledge there are only four previous reports of cocaine-associated ASR[21-23], making this quite a rare phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Atraumatic splenic rupture after cocaine use and acute Epstein-Barr virus infection: A case report and review of literature

Kwok¹

2019

WJGS

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BACKGROUNDAtraumatic splenic rupture (ASR) accounts for just over 3% of all cases of splenic rupture and is associated with a high mortality rate. The most common culprit is acute infection with Epstein-Barr virus (EBV) but other documented aetiologies include neoplasia, other viral/bacterial infections, acute and chronic pancreatitis, amyloidosis and anticoagulant medications. There are four previous reports of cocaine-associated ASR but never before has it been documented in combination with concurrent acute EBV infection.CASE SUMMARYA 21-year-old man presented to hospital with acute left shoulder pain which radiated to the right shoulder and upper abdomen. He denied any history of recent trauma and had no relevant past medical history. He took no regular prescription medications but had used cocaine within the previous 24 h. Investigations revealed splenomegaly, a Grade 3 subcapsular splenic haematoma, moderate haemoperitoneum and an incidental 9 mm splenic artery pseudoaneurysm. There was also serological evidence of acute EBV infection. Prophylactic endovascular embolisation of the pseudoaneurysm was performed and the splenic rupture was managed non-operatively. The patient remained admitted in hospital for seven days and did not require any transfusion of blood products. Serial imaging showed complete resolution of the haemoperitoneum after 5 wk. The importance of abstinence from illicit drug use was emphasised to the patient but it is unknown whether or not he remains compliant.CONCLUSIONThis case demonstrates that ASR is a rare condition that can result from acute EBV infection and cocaine ingestion and requires a high index of suspicion to diagnose clinically.

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Cocaine-associated hemoperitoneum following atraumatic splenic rupture: a case report and literature review

Cited by 9 publications

References 8 publications

Cocaine-induced splenic rupture

Cocaine-induced splenic rupture

Cocaine Use and Splenic Rupture: A Rare Yet Serious Association

Atraumatic splenic rupture after cocaine use and acute Epstein-Barr virus infection: A case report and review of literature

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