A case of spontaneous splenic rupture during chemotherapy for B-cell chronic lymphoid leukemia |
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Authors: | Yuka Sueyoshi Toshiyuki Yoshio Mari Ito Shigeki Suemura Manabu Araki Chiaki Mitsuta Makiyo Ota Takashi Ohta Hiroko Hasegawa Kaori Tatsumi Takashi Toyama Shoichi Nakazuru Noriyoshi Kuzushita Masanori Tsujie Atsushi Miyamoto Shoji Nakamori Yoshinori Kodama Eiji Mita |
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Institution: | 1. Department of Gastroenterology and Hepatology, Osaka National Hospital, 2-1-14 Houenzaka, Chuo-ku, Osaka, Osaka, 540-0006, Japan 2. Department of Surgery, Osaka National Hospital, Osaka, Japan 3. Department of Pathology, Osaka National Hospital, Osaka, Japan
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Abstract: | Spontaneous splenic rupture is a life-threatening disease and an important differential diagnosis of acute abdomen. Early clinical diagnosis and rapid intervention is required to ensure patient survival. Spontaneous splenic rupture may be induced by hematological, inflammatory or infiltrative diseases affecting the spleen. Splenomegaly may also significantly increase the risk of rupture. Other contributory factors include male, adulthood, rapid growth of the spleen and splenic abscess. Here, we present the case of a 69-year-old man who was undergoing chemotherapy for B-cell chronic lymphoid leukemia. He was admitted to our hospital after he suddenly developed persistent upper abdominal pain. Computed tomography and ultrasonography revealed accumulation of free fluid in and around the spleen. He was diagnosed as having spontaneous splenic rupture and an emergency operation was performed. During the operation, we found a massively enlarged spleen with several capsular tears, and performed a splenectomy. The patient made a good recovery. Pathological examination revealed that the spleen was infiltrated by CD20-, CD5- and CD23-positive lymphoid blasts. We encountered a case of spontaneous splenic rupture in a patient receiving chemotherapy for exacerbating B-cell chronic lymphoid leukemia. In a case of abdominal pain of acute onset in patients with hematological disease, spontaneous splenic rupture should be suspected. |
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