Characteristics of Patients With Spontaneous Splenic Rupture

In the present study, we aim to share our clinical experience in patients with spontaneous splenic rupture. Splenic rupture without trauma is known as spontaneous splenic rupture. The major problems in the management of spontaneous splenic rupture are missed or delayed diagnosis due to the lack of trauma in most cases. The records of all patients, who were admitted to Cerrahpaşa Medical Faculty, Istanbul University, were retrospectively reviewed from January 2000 to March 2013. Twelve patients were admitted to the emergency department and they were diagnosed with spontaneous splenic rupture. The mean age was 47.6 years. All patients had complaints of abdominal pain. The mean hematocrit value was 22%. Radiologic assessment revealed hemoperitoneum and/or subcapsular hematoma in 8 patients while splenic abscess was diagnosed in 2 patients. Eleven patients underwent splenectomy whereas one was managed conservatively. The most common cause of spontaneous splenic rupture was determined to be use of anticoagulants. Etiology was considered to be idiopathic in 1 patient. Two patients died in the postoperative period. Although rare, spontaneous splenic rupture must be suspected in emergency patients who have used especially anticoagulants and antiaggregants and who have had no recent history of trauma. One of the important causes of mortality is missed or delayed diagnosis.Key words: Spontaneous, Atraumatic, Splenic rupture, Drug use, MortalityAlthough splenic rupture often occurs in association with the trauma, it may appear due to causes other than trauma, and has a fatal course. Ruptures occurring without trauma are often called spontaneous or atraumatic splenic rupture in the literature.^1,2 They are extremely rare and the frequency remains unclear. A study reported the plausible incidence to be 0.1–0.5%.³ It usually develops due to a pathologic cause such as malignancy or infection. It may develop less frequently in a normal spleen without being associated with any pathology and refers to idiopathic splenic rupture.⁴ It is an important problem because it delays the definitive diagnosis in patients without the history of trauma, resulting in disastrous consequences.The data are poor on the characteristics of the patients, etiology, and incidence of the disease. This study aims to identify the characteristics, etiology, and the diagnostic and therapeutic processes of patients with splenic rupture occurring in the absence of trauma and to highlight our approach to less commonly encountered cases.