Occult rupture of the spleen

McMahon, Michael; Lintott, J. D.; Mair, W. S. J.; Lee, P. W. R.; Duthie, J. S.

doi:10.1002/bjs.1800640910

Cited by 26 publications

(12 citation statements)

References 4 publications

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“…In a review of the literature, we have been able to identify 17 cases of splenic rupture associated with amyloidosis reported since 1948 [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Although this number does not define the actual incidence of spontaneous rupture of the spleen in amyloidosis, it suggests the splenic rupture is a rare complication in this disease.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous rupture of the spleen in AL amyloidosis

et al. 2003

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The frequency of splenic involvement in AL amyloidosis is not precisely known. However, splenomegaly has been reported in 4-13% of patients. We report four cases of spontaneous splenic rupture in patients with AL amyloidosis. Splenic rupture was the initial manifestation of the disease in one of these patients. The other three experienced splenic rupture during or after high-dose intravenous melphalan with autologous peripheral blood stem cell transplantation (HDM/SCT): one during stem cell mobilization with G-CSF prior to HDM/SCT and two after hematopoietic recovery following treatment. Two of the four patients had Factor X deficiency, the most common coagulation abnormality associated with AL amyloidosis. All four patients underwent splenectomy without significant postoperative complications. Splenic rupture in AL amyloidosis as a complication of aggressive treatment with HDM/SCT has not been reported previously. Am.

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Section: Discussionmentioning

confidence: 99%

Spontaneous rupture of the spleen in AL amyloidosis

et al. 2003

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“…Splenic rupture was found at the postmortem examination. Usually, prompt diagnosis of the splenic rupture is difficult because the physical findings are not specific (9). A diffuse interstitial pattern with or without pleural effusion is seen on the chest X-P in cases with pulmonary amyloidosis (10).…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Rupture of the Amyloid Spleen in a Case of Usual Interstitial Pneumonia.

et al. 2001

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Wedescribe a rare case of secondary amyloidosis associated with usual interstitial pneumonia (UIP), who died from spontaneous rupture of the amyloid spleen. A 68-yearold man was admitted to evaluate to his interstital lung disease. Chest radiography showed reticular shadow in bilateral lower lung fields. Two years later, he suddenly felt severe abdominal pain. In spite of maximumtherapy, he died from hypovolemicshock. Postmortemexamination revealed massive intraabdominal hemorrhage. The diagnosis of lung disease was UIP and amyloid A type deposits were observed in various organs including the ruptured spleen. (Internal Medicine 40: 428-431, 2001)

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“…It is generally thought to be caused by rapid expansion of the splenic capsule, which has become rigid because of amyloid deposits and then ruptures [8,37,481. Fragility of the vascular red pulp from amyloid infiltration of the blood vessel walls [2,24,32,35,371, and coagulation abnormalities including factor X deficiency and prothrombin time prolongation 126,501, may also be contributory factors.…”

Section: Discussionmentioning

confidence: 99%

Liver transplantation as rescue treatment in a patient with primary AL kappa amyloidosis

Nowak¹,

Westermark

Wernerson

et al. 2000

Transplant Int

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Although involvement of the liver is common in systemic amyloidosis, clinical manifestations of hepatic dysfunction and liver biochemical abnormalities are often absent or only mild. Here we report on a patient with primary amyloidosis and rapid development of liver failure, who was successfully treated by liver transplantation. The patient is a 61-year-old Swedish man who was admitted to the local hospital for spontaneous rupture of the spleen. Before admission, he had suffered from diffuse upper abdominal discomfort, diminished appetite, and had lost 15 kg in 6 months.Shortly after splenectomy, he developed cholestatic liver failure with moderate hepatomegaly, jaundice, ascites and hyponatremia. Over a period of 3 weeks his liver failure progressed, renal function deteriorated rapidly, and he developed encephalopathy. Liver transplantation was performed on the 35th day after splenic rupture. Histological examination revealed extensive deposits of arnyloid in the spleen and liver. N-terminal amino acid sequence analysis of the amyloid protein, purified from the patient's native liver, revealed an AL protein of kappa I-type origin. The postoperative course was uncomplicated, apart from one episode of sepsis and one course of treatment for acute rejection. He was discharged from hospital with normal liver function and good kidney function. One year after surgery, he was in good condition, with normal liver function. However, a liver biopsy taken at the same time showed de novo amyloid deposits in the grafted liver. We conclude that liver transplantation may be indicated as a life-saving procedure in rapidly progressing hepatic amyloidosis with cholestatic jaundice, although the underlying disease has not changed.

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Occult rupture of the spleen

Cited by 26 publications

References 4 publications

Spontaneous rupture of the spleen in AL amyloidosis

Spontaneous rupture of the spleen in AL amyloidosis

Spontaneous Rupture of the Amyloid Spleen in a Case of Usual Interstitial Pneumonia.

Liver transplantation as rescue treatment in a patient with primary AL kappa amyloidosis

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