Spontaneous splenic rupture: A rare complication of acute myeloid leukemia. Report of a case. (May 2021)

• Record Type: Journal Article
• Authors: Hajri, Amal; Yaqine, Karim; El Massi, Salaheddine; Errguibi, Driss; Boufettal, Rachid; El Jai, Saad Rifki; Chehab, Farid
• Is Part Of: Annals of medicine and surgery. Volume 65(2021)
• Publication Date: 2021-05
• Subjects: Acute myeloid leukemia -- Splenic rupture -- Splenectomy; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2021.102286
• Languages: English
• ISSNs: 2049-0801

Abstract

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. Highlights: The objective of this study is to highlight the seriousness of this condition and the different diagnostic and therapeutic modalities. Spontaneous rupture of the spleen (SPR) is a rare and severe affection, difficult to diagnose. 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.