Spontaneous Splenic Rupture in a Hemodialysis Patient

Abstract

Spontaneous splenic rupture (SSR) in a patient undergoing hemodialysis has been described as an extremely rare and potentially fatal complication. We report here spontaneous splenic rupture in a 52-year-old woman undergoing regular hemodialysis for end-stage renal disease (ESRD). She complained of colicky abdominal pain in the left upper quadrant area and dizziness when she assumed an upright posture. Her vital signs revealed low blood pressure and tachycardia, which was suggestive of hypovolemic shock. Abdomen CT scan showed splenic hematoma and hemoperitoneum. However, she had no history of any event triggering the splenic rupture. An exploratory laparotomy showed a ruptured spleen and an emergency splenectomy was performed. We suggest that spontaneous spleen rupture may be attributed to uremic coagulopathy and heparin-induced coagulopathy.

Spontaneous splenic rupture in a patient who received haemodialysis: case report and a review of the literature

“…But not all spontaneous rupture of spleen requires splenectomy 3 5. In those who are haemodynamically stable and have no sign of impending rupture, conservative treatment, such as embolisation of the splenic artery, subsegmental resection or transposition of the spleen, is the first choice.…”

Spontaneous Arterial Calcification: A Possible Etiology for Spontaneous Splenic Rupture in a Patient on Maintenance Hemodialysis

“…It is commonly associated with various etiologies, including infiltrative malignancy, infectious disease, splenic infarction, anticoagulation therapy, connective tissue disease, venous thrombosis, or focal splenic lesions [2]. Although many etiologies are related to SSR, its exact mechanism is not clearly understood because SSR has occurred in normal spleens without pathologic findings [3].…”

“…Infection, hematologic disorders, and neoplastic changes are usually linked with this complication [1]. Such diseases occur in patients with chronic renal failure, and risk factors include long-term heparin use, uremic coagulopathy and susceptibility to infectious diseases [2]. However, vascular abnormality has rarely been mentioned as an etiology of SSR.…”

Spleen Rupture Associated with Septic Emboli and Endocarditis in a Hemodialysis Patient

“…Hemodialysis patients with chronic renal failure show a fibrinolysis defect at the level of plasminogen activation [19]. Fluid overload with edema of the spleen and formation of a subcapsular hematoma (secondary to uremic coagulopathy and use of heparin in those who are on hemodialysis) may occur in uremia [20]. …”