Delayed splenic rupture in a haemophiliac

Abstract

We report an unusual case of post-traumatic delayed rupture of the spleen occurring in a 38-year-old man with haemophilia A. The time interval between injury and splenic rupture was at least 2 weeks. Although a rare event, the possibility of splenic rupture should always be considered in the differential diagnosis in patients with a bleeding disorder and abdominal pain, even when the patient does not initially give a history of abdominal injury. Radiological imaging, including ultrasound examination, is of great value in establishing the diagnosis. This case report includes a brief review of other similar cases.

Splenectomy in severe haemophilia

“…Three of these were paediatric 22,34 and one was in an adult with only mild haemophilia 35 (a plasma factor VIII activity of 14%, with no treatment required in the 15 years prior to his presentation). Most cases have been managed with primary emergency splenectomy 15−33 and we are of the opinion that in severe haemophilia, this should be the course of action.…”

Blunt abdominal trauma with delayed rupture of splenic haematoma in a haemophiliac patient

“…Splenectomy was performed in the remaining 13 cases. The time interval from presentation to splenectomy ranged from 1 day to 5 weeks [1–8,10–13,17]. All of these patients recovered except one patient who died due to congestive cardiac failure 17 days after the surgery [5].…”

“…In addition to trauma, disorders such as infectious mononucleosis and chronic malaria may predispose to spontaneous splenic rupture with life‐threatening intra‐abdominal bleeding [1]. There are only a few case reports of splenic rupture in patients with inherited bleeding disorders [1–17]. We report a case of post‐traumatic splenic haematoma in a haemophilia A patient whereby after initial conservative management with factor VIII (FVIII) replacement therapy for 1 month, delayed rupture of the haematoma occurred.…”

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Splenic rupture is a well-known complication of trauma to abdomen. In addition to trauma, disorders such as infectious mononucleosis and chronic malaria may predispose to spontaneous splenic rupture with life-threatening intra-abdominal bleeding [1]. There are only a few case reports of splenic rupture in patients with inherited bleeding disorders [1±17].

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