yes

1. • :
GENERAL EXAMINATION
O/E:
Pt conscious
Oriented
Febrile
No pallor, icterus, cyanosis, clubbing, generalized
lymphadenopathy, edema
Vitals –tachycardia +
• Splenic rupture is a potentially life-threatening
condition, often associated with chest or abdominal
trauma. Spontaneous rupture is very rare and is
usually reported as being secondary to underlying
pathological conditions
CASE CAPSULE
ABDOMEN EXAMINATION
• Warmth & tenderness present in the left upper quadrant
• Intercostal tenderness
• Localised guarding present
• No rigidity
• No organomegaly
• No evidence of free fluid
• Bowel sounds present
• DRE : Normal fecal staining present
GOVT STANLEY MEDICAL COLLEGE
A CASE REPORT OF SPONTANEOUS RUPTURE OF SPLEEN
GUIDE PROF.DR A.ANANDI M.S(GENERAL SURGERY)
• A 57 year old male chronic smoker and chronic
alcoholic k/c/o ? PTB treated came with
• complaints of upper quadrant abdominal pain for 1 day
.
• h/o fever for 2 weeks
• On and off
• Low grade
• Took symptomatic treatment in local hospital
• c/o breathlessness for 1 day
• CECT ABDOMEN AND PELVIS :
• Hyper dense free fluid in the peritoneal cavity
and pelvis with predominantly in perisplenic
region .
• Spleen appears enlarged with multiple ill
defined non enhancing linear lacerations noted
in the splenic parenchyma radiating from the
hilum to the posterior costal surface.
• Splenic artery , splenic vein shows normal
opacification .
• No evidence of active contrast extravasation
noted.
• Impression : Spontaneous splenic rupture with
hemoperitoneum .
• USG ABDOMEN AND PELVIS :
• An ill defined hypoechoic collection measuring
8.5x3.5x2 cm in the subsplenic region

2. • MANAGEMENT
• Serial USG did not show an increase in collection
• Patient was managed with elective delayed splenectomy after 30 days of presentation.

3. •
• DISCUSSION
• Atraumatic splenic rupture was first documented in the 19th century.
• Since then it has been associated with several underlying pathologies, including
• infectious (e.g. malaria and glandular fever),
• gastrointestinal (e.g. pancreatitis),
• haematological (e.g. lymphoma) and
• systemic (e.g. sarcoidosis) .
• In the absence of trauma, diagnosis of splenic rupture is not always made by considering just the
• classic signs and symptoms of left upper quadrant (LUQ) pain,
• guarding and
• haemodynamic instability .
• As in the case presented, the atraumatic history and absence of underlying pathologies meant that only the symptoms of left-sided
abdominal pain (not specifically LUQ pain) and sudden haemodynamic instability should raise the suspicion of splenic rupture.
• Left shoulder-tip pain resulting from diaphragmatic irritation (Kehr’s sign) is reported in approximately 50% of cases .
• Clinicians should have a high index of suspicion in diagnosing atraumatic splenic rupture; particularly in a patient with isolated left-sided
abdominal pain.
• Other differentials in such a patient would include
• cardiac ischaemia,
• pulmonary embolism,
• pneumonia,
• peptic ulcers with perforation or
• ruptured sigmoid diverticulitis
• A CT scan is often essential to make the diagnosis and grade the splenic injury, although an ultrasound scan may be clinically useful.
• The most common finding on CT is splenomegaly with splenic lacerations and intraperitoneal or subcapsular bleeding.
• Low-grade injuries (I–II) may be managed conservatively, whereas higher-grade (IV–V) injuries generally require surgery
CONCLUSION
• There is, however, evidence that the clinical situation should be the most important factor in guiding management decisions .
• Even patients with high-grade splenic injuries may be managed conservatively if they are haemodynamically stable.
• Conversely, splenic rupture requiring delayed surgery may occur in patients whose initial CT shows low-grade splenic injury