Spontaneous splenic rupture: A rare complication of acute myeloid leukemia. Report of a case

Abstract

Introduction Spontaneous rupture of the spleen (SPR) is a rare and severe affection, difficult to diagnose, with multiple causes such as: Infectious and hematologic affections which represent more than half of the cases. Among this subset of patients, acute myeloid leukemia is one of the causes. Presentation of case A 48-year-old man undergoing chemotherapy for acute myeloid leukemia presented with acute intense abdominal pain. Computed tomography showed Abdominal CT scan showed a splenic rupture with abundant hemoperitoneum and bilateral pleural effusion. The patient presented hemodynamic instability and was immediately operated, splenectomy were performed. Discussion Spontaneous rupture of the spleen usually presents as a severe abdominal syndrome, which may accompany non-specific symptoms.Two signs are suggestive of splenic rupture: Kehr's sign (left diaphragmatic irritation resulting in referred pain to the left shoulder) and Balance's sign (palpable tender mass in the left upper quadrant. Diagnostic methods of choice are computed tomography andultrasound. The prognosis is depending on the quality of care and the nature of the etiology. Splenectomy remains the cornerstone of the treatment of splenic rupture. It is important to include splenic rupture as a differential diagnosis for acute abdominal pain, especially in patients with hematologic malignancy, since early recognition and treatment increase patient survival and improve the prognosis. Conclusion Even if spontaneous splenic rupture is rare, every clinician should have in mind the reflex to think of it, especially in patients with hematologic malignancies.

Spontaneous splenic rupture in marginal zone lymphoma at presentation

“…Thus, clinical pictures of SSR may vary depending on the rupture size, as well as on possible adhesions around the spleen preventing major bleeding in a short period of time. Typically, it is followed by abdominal pain radiating toward the left hemithorax and the left shoulder, as seen in our patient, nausea, vomiting, and hemodynamic changes [4,5]. In rare cases, pain may be absent, so that possible rupture should be considered if patients with splenomegaly develop a hemodynamic change.…”

“…In unclear cases, a diagnostic lavage of the peritoneal cavity may be recommended [8]. If the rupture is a major one, serious bleeding can occur and requires urgent diagnosis and surgery; otherwise, it may have a fatal outcome [5,9,10]. It is important to know that there is no laboratory or imaging method to predict a rupture, so it is important to take the possibility into account.…”

Atraumatic Splenic Rupture is a Rare Complication of Acute Myeloid Leukemia: A Case Report and Literature Review

“…Unfortunately, the patient had cardiovascular decompensation after surgery and died on the seventh day (7). Our patient had an uneventful postoperative period and was discharged from the surgical ward in good general condition.…”