Spontaneous splenic rupture in atypical (Philadelphia chromosome negative) chronic myeloid leukaemia following blastic crisis

Philadelphia chromosome negative and bcr/abl negative chronic myeloid leukaemia (CML) is an uncommon atypical CML. We describe a patient with this disorder who experienced an acute blastic transformation that resulted in rapid splenic enlargement and subsequent atraumatic splenic rupture. Clinically, spontaneous splenic rupture may be a difficult diagnosis to make and this case highlights the importance of considering atraumatic splenic rupture as a cause for unexplained abdominal pain in a patient with a haematological malignancy.     

Hepatic and splenic rupture associated with severe preeclampsia: a case report

The splenic rupture is a rare complication of pregnancy and of the postpartum period. On the contrary, hepatic hemorrhage is a relatively common complication of pregnancy and it is usually associated with preeclampsia. In this work we report the case of a 37 year-old patient with a noncontrolled 35 week-pregnancy of simple, with severe preeclampsia. She presented abdominal pain, headache, hypertension and accented cutaneous-mucous paleness at the moment of admission to the hospital. During physical evaluation at admittance, the patient suddenly suffered a severe circulatory collapse and it was decided a surgical intervention. A segmental caesarean section was practiced, and during the abdominal exploration it was observed hemoperitoneous, a splenic rupture degree III and a hematoma in the anterolateral liver's wall. Total splenectomy and evacuation of the hepatic hematoma was performed. The splenic rupture and the hepatic subcapsular hematoma should be considered as a part of the differential diagnoses when a hemodynamic collapse occurs during labor in patients with severe preeclampsia. This work constitutes the first report in the Venezuelan literature of the association of splenic rupture, hepatic subcapsular hematoma and severe preeclampsia. An appropriate prenatal control, the knowledge of this association and an immediate therapeutic intervention are essential to assure the maternal-fetal survival.     

Splenic rupture, beyond and behind: a histological, morphometric and follow-up study of 254 cases.

OBJECTIVE: Population-based data regarding splenic rupture causes are sparse. To systematically characterize histology and morphometry of splenic rupture, we performed a retrospective clinicopathological study of 254 patients. METHODS: Our electronic data base was reviewed and all splenic rupture cases were morphologically, morphometrically and, where needed, molecularly analyzed. Clinical and follow-up data were gained by reviewing patient charts. A formula to calculate splenic volume based on size was established and results were compared to the actual volumes. RESULTS: Ruptured spleens presented 0.1% of all gross surgical pathology specimens. Nearly 90% were due to trauma and approximately 10% were pathologic, being associated with underlying diseases (5% with unexpected diseases) such as splenic angiomas, granulomatous diseases, infarctions, hepatopathies, cysts, hemorrhagic diatheses, hematological neoplasms, metastatic carcinoma and collagenosis. Men were more often affected than women. Morphometric analysis showed distinct splenic weights, volumes and capsule thicknesses with respect to the different rupture causes. Pathological ruptures were predominantly observed in elderly, male patients with larger spleens. CONCLUSIONS: Splenic rupture is due to an often unexpected underlying disease in approximately 10% of the cases. This should be kept in mind when dealing with susceptible patient groups.     

Atraumatic rupture of the spleen associated with hemophagocytic syndrome and isolated splenic peliosis. Case report

Atraumatic rupture of the spleen is an uncommon condition that may be associated with various etiologies. The hemophagocytic syndrome (HS) and isolated splenic peliosis are two rare conditions, each of which has previously been described in association with splenic rupture. We describe a unique case of atraumatic splenic rupture in which concurrent HS and splenic peliosis were diagnosed following splenectomy. Given that both these rare conditions have probably caused the splenic rupture, a possible association between these entities is discussed.     

Case report: spontaneous splenic rupture during acute parasitemia of Babesia microti

Babesia is a malaria-like protozoan parasite spread by Ixodes ticks primarily from the white-footed deer mouse to humans. Typically it causes subclinical disease, but occasionally causes acute febrile disease with hepatosplenomegaly. We report a case of spontaneous splenic rupture of a 56-yr-old man with acute Babesia microti infection.     

Anemia causes erythropoiesis and increased antibody synthesis in the spleen of the pregnant mouse

The role of anemia in the induction of splenic alterations during pregnancy has been studied in mice and rats. The enlarged spleens of 12 day pregnant CBA mice typically showed 1) dramatic increase in numbers of esterase-positive cells (mainly erythroblasts) and 2) increase in numbers of immunoglobulin-secreting cells. Pregnant Sprague-Dawley rats showed slight enlargement of the spleen, no change in the content of esterase-positive cells, but a clearcut increase in numbers of Lepehne-stained erythroblasts and immunoglobulin-secreting spleen cells. Virgin mice and rats were made anemic by bleeding or phenylhydrazine-treatment. These animals showed very much the same splenic alterations as those of pregnant mice and rats. In a final experiment pregnant CBA mice were subjected to transfusion of washed syngeneic red blood cells in order to normalize their erythrocyte counts. These mice showed 1) reduced splenomegaly, 2) reduced increase in numbers of esterase-positive cells and 3) reduced numbers of immunoglobulin-secreting cells. It was concluded that pregnancy-associated anemia (erythropenia) is a major reason to the gross change in size and cell content of the maternal spleen.     

外伤性脾破裂保脾治疗32例临床分析

目的:探讨保脾治疗在外伤性脾破裂中的应用.方法:采用保脾疗法治疗外伤性脾破裂患者32例.结果:10例行非手术治疗;22例行保脾手术治疗,其中16例行缝合修补术,4例行脾部分切除术,2例行脾切除加自体脾片移植术.32例均治愈,随访无并发症发生.结论:只要符合保脾条件,非手术治疗和保脾手术治疗外伤性脾破裂是可行的,年龄越小越倾向于保脾治疗.     

Spontaneous bilateral cornual uterine dehiscence early in the second trimester after bilateral laparoscopic salpingectomy and in-vitro fertilization: case report.

A bilateral cornual uterine dehiscence is reported, which occurred 14 weeks after in-vitro fertilization (IVF) in a patient having a medical history of previous bilateral salpingectomy via laparoscopy. Uterine rupture is a rare obstetric complication usually occurring during the third trimester of pregnancy within a uterus which has previously undergone an operation. Ectopic pregnancy is a well known complication of IVF. Post-salpingectomy cornual localization with rupture has also been published. Possible causes are discussed and the attention of the counselling physician is directed to the necessary awareness of such a complication in this high risk population. The reported case is an extreme rarity: a similar case has not been previously published in the literature.     

Dissociation of the res and immune components in the transient splenic response of embryos and neonatal chicks to immunization

Immunization with mouse erythrocytes (MRBC) elicited transient splenic enlargement as well as PFC formation in immunocompetent 7, 10, and 14 day chicks. An early enlargement within two days was followed by a decline and a second enlargement by day six. Only the early enlargement was observed when MRBC or Percoll was administered to neonatal chicks and late embryos. No significant splenomegaly was observed following cell transfer of bone marrow, spleen, leucocyte, thymocyte or bursal cell suspensions from B haplotype-compatible donors. During the adoptive immune response in embryo hosts, a minor early peak was observed that was followed by an elevated or progressive increase in spleen size. The data suggest that the early splenic response reflects primarily RES-vascular activity and the later enlargement is the consequence of immune proliferation.     

Ruptured spleen as a differential diagnosis in ruptured tubal pregnancy

Two cases of traumatic biphasic or secondary splenic rupture are presented to demonstrate the clinical picture of an entity the obstetrician-gynecologist will be encountering more commonly in the future. The signs and symptoms of this condition figured prominently in the differential diagnosis of ruptured tubal pregnancy.     

A Case of Pathologic Splenic Rupture as the Initial Manifestation of Acute Myeloid Leukemia M2

A pathologic splenic rupture refers to a rupture without trauma. A splenic rupture as the initial manifestation of acute myeloid leukemia is extremely rare. In this study, we described a rare case of acute myeloid leukemia presenting principally as an acute abdomen due to a pathologic splenic rupture in a 35-year old male patient. We can assert that a pathologic splenic rupture in hematologic diseases is a potentially life-threatening complication, which necessitates immediate operative intervention. Any such patient complaining about left upper abdominal tenderness should be closely observed, and further diagnostic investigations (ultrasonograph of the abdomen, abdominal CT scan) should be initiated in order to rule out a splenic rupture. The oncologist should be aware of this rare initial presentation of acute myeloid leukemia (AML) M2, as the condition generally necessitates a prompt splenectomy.     

A delayed splenic rupture after transcatheter arterial embolization required total splenectomy in a patient with an implantable left ventricular assist device

We successfully managed a splenic injury and delayed splenic rupture in a patient with an implantable left ventricular assist device (iLVAD). A 42-year-old man with an iLVAD for idiopathic dilated cardiomyopathy was admitted to our department complaining of dizziness. Laboratory data showed severe anemia, and computed tomography demonstrated a traumatic splenic injury. Following conservative treatment, partial splenic embolization was performed. Fifteen days after the intervention, the patient went into hemorrhagic shock due to delayed splenic rupture. Emergency total splenic embolization was performed, and total splenectomy was conducted later to prevent re-bleeding or abscess formation. His postoperative course was uneventful, and he was discharged on postoperative day 22. Finally, he underwent orthotropic heart transplantation without post-splenectomy sepsis or thrombotic complications 472 days after splenectomy. Splenic injury should be considered as a possible complication of iLVAD. In addition, careful follow-up after transcatheter arterial embolization for splenic injury is essential for managing delayed splenic rupture.     

Spontaneous splenic rupture in a hemodialysis patient

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.     

Geometrical factors as predictors of increased growth rate or increased rupture risk in small aortic aneurysms

Abdominal Aortic Aneurysms (AAAs) are focal dilation of the aorta that can lead to excessive enlargement and rupture over time. Current practice suggests intervention when the maximum diameter exceeds 5.5 cm, since in this diameter range the annual rupture risk outweighs the operative mortality. However, small AAA (<5.5 cm), though infrequently, may rupture or produce symptoms. Evidence from large randomized studies of small AAAs support the heterogeneity in patterns of growth and rupture potential among small AAAs. Elevated wall stress values have been implicated in AAAs rupture and rapid enlargement. Additionally, many studies have identified a strong correlation between certain geometric factors and elevated stress values. In this article we discuss the possibility that geometrical factors may have a predictive value to identify those small AAAs that have an increased risk of rupture or growth rate either during initial examination or during follow-up, making them amenable for early repair.     

Splenic haemodynamics and portal hypertension in patients with liver cirrhosis and spleen enlargement

The relationships between portal hypertension and spleen enlargement, in patients with liver cirrhosis, are not clearly defined; as well as those between splenic haemodynamics and portal hypertension. In 25 cirrhotics with spleen enlargement and portal hypertension and in seven controls, the following parameters were determined: estimated splenic volume (ESV) from the radiographic view of the spleen, according to Blendis, Williams and Kreel (1969), specific splenic blood-flow (SSBF), total splenic blood-flow (TSBF), porto-hepatic gradient (PHG), specific splenic resistance (SSR) and total splenic resistance (TSR). Moreover, the size and extension of oesophageal varices, at oesophagoscopy, were classified according to Dagradi (1973). PHG, ESV and TSBF were increased in all subjects, SSBF was increased in two cases, SSR was increased in two cases and decreased in two cases, TSR was decreased in all cases and ESV was not correlated to the level of portal hypertension. Neither TSBF nor TSR were found to be correlated to the level of portal hypertension, as estimated by PHG or by oesophageal varices. It is concluded that, in patients with liver cirrhosis and spleen enlargement, splenomegaly is likely to be the consequence of pulp hyperplasia and not of passive congestion, and that increases in splenic blood-flow do not contribute significantly to portal hypertension.     

Acute lymphocytic leukemia manifesting as splenic rupture.

Pathologic rupture of the spleen is a rare phenomenon in acute lymphocytic leukemia, and its mechanism is unknown. This complication has been seen almost exclusively in men, and at ages much older than those of the majority of patients who have this leukemia; these unusual features are also unexplained. A case of acute lymphoctyic leukemia with pathologic rupture of the spleen in which the pathologic findings suggest that the splenic rupture was due to infiltration and destruction of the splenic capsule by leukemic cells is reported.     

Spontaneous uterine rupture in the first trimester: a case report

Uterine rupture is one of the most feared obstetric complications affecting the pregnant woman and fetus. Most of the cases have various risk factors and mainly occur during the second or third trimester. However, spontaneous uterine rupture during the first trimester is extremely rare. We experienced a case of spontaneous uterine rupture in a 36-yr-old multiparous woman without definite risk factors. The initial impression was a hemoperitoneum of an unknown origin with normal early pregnancy. Intensive surgical method would be needed for accurate diagnosis and immediate management in bad situation by hemoperitoneum even though a patient was early pregnancy.     

Splenic rupture following idiopathic rupture of the urinary bladder presenting as acute abdomen

Idiopathic rupture of the urinary bladder is an uncommon condition and represents less than 1% of all bladder rupture cases. In most of the cases the main etiological factor was heavy alcohol ingestion. A combined injury of the spleen and bladder is a very rare condition that is almost often associated with trauma and foreign bodies. In this paper we present the extremely rare clinical course of acute abdomen caused by a combined spontaneous intraperitoneal injury; spontaneous rupture of the urinary bladder and spleen. According to our opinion, spontaneous bladder rupture caused by bladder distension due to alcohol ingestion led to urinary ascites and abdominal distension. Finally, repeated minor abdominal blunt trauma during everyday life, to a moderately distended abdomen caused a spontaneous splenic rupture in the patient with abnormal coagulation studies.     

Spontaneous rupture of splenic artery aneurysm in pregnancy: a case report

Splenic artery aneurysms (SAA) occur predominantly in women, and the majority of them are asymptomatic until rupture. Over half of those that rupture occur during pregnancy. Spontaneously ruptured SAA during pregnancy is always a life-threatening surgical entity for both the mother and the fetus. We report the case of a 29-year-old woman at 34 weeks' gestation with spontaneous rupture of SAA who underwent emergency exploratory laparotomy and splenectomy. This case illustrates the need to consider ruptured SAA as part of important differential diagnosis in haemodynamically unstable pregnant women.     

Glomerular structural changes in pregnant, diabetic, and pregnant-diabetic rats

Kidneys enlarge both during pregnancy and in diabetes. The enlargement and morphology of glomeruli was studied during pregnancy and in diabetes in order to examine possible similarities, differences, and interactions in the growth in these conditions. Morphometric investigations were performed on glomeruli in pregnant rats, in rats with 2 weeks' diabetes, and in pregnant-diabetic rats. Kidneys were enlarged 22% in the midterm pregnant rats compared with controls, 74% in diabetic rats, and a further 21% in pregnant-diabetic rats. Glomerular volume was enlarged by 26% during midterm pregnancy in normal animals. Diabetes induced an enlargement in glomerular volume of 58% and a further 18% in midterm diabetic animals due to pregnancy. Within the glomerulus, pregnancy in normal animals induced minor non-significant changes. Diabetes induced significant increase in several parameters: mesangial volume and cell volume, capillary and glomerular basement membrane volume, capillary wall surface area, foot process width, filtration slit length, and nuclear number. Pregnancy in diabetic animals induced no significant additional changes. In conclusion, kidney enlargement in pregnancy shows very few glomerular changes in either normal or diabetic animals. Enlargement of glomeruli in diabetes involves hypertrophy and hyperplasia concurrent with several morphological changes within the glomerulus.