| The author describes two cases of spontaneous splenic rupture occurring with infectious mononucleosis in young, previously healthy patients. The reports illustrate the variable clinical presentation--from sudden, fatal hemorrhage to bleeding that stops spontaneously. Although conservative nonoperative treatment may be successful in carefully selected cases, laparotomy with splenectomy appears to be the safest therapeutic approach. When a nonoperative approach is selected, the patient should be observed in a critical-care facility with immediate access to an operating room. Normal activity should not be resumed until the spleen has returned to its normal size as demonstrated by computed tomography or ultrasonography. ( info) |
362/417. Fatal spleen rupture during induction chemotherapy with rh GM-CSF priming for acute monocytic leukemia. Clinical case report and in vitro studies. Recombinant human (rh) granulocyte-macrophage colony-stimulating factor (GM-SCF) is currently being tested in clinical trials for the treatment of acute myeloid leukemias with two main intentions: reduction of neutropenia and recruitment of leukemic blasts into cell cycle to enhance cytarabine (ara-C) mediated cytotoxicity. We report a case of a fatal spleen rupture in a patient with acute monocytic leukemia (AML M5b) who was treated according to a clinical phase I/II protocol with rh GM-CSF priming and standard induction chemotherapy TAD 9 (thioguanine/ara-C/daunorubicin). During treatment we observed rapidly rising peripheral blast counts and the development of an acute abdomen. Ultrasound examination revealed splenomegaly due to diffuse cellular infiltration and spleen rupture. The patient died 17 days later due to pneumonia and renewed spleen hemorrhage. bone marrow progenitor assays before treatment showed exclusive growth of monocytoid blast cell colonies (CFU-L). Colony growth could be stimulated with rh GM-CSF and blocked dose-dependently by a monoclonal anti-GM-CSF antibody. CFU-L proliferation also increased after stimulation with rh interleukin-3 (rh IL-3) and supra-additively with rh granulocyte colony-stimulating factor (rh G-CSF) combined with rh GM-CSF. Furthermore, rh GM-CSF induced surface marker expression of CDw 65 and CD 11b on isolated CFU-L blasts. After short-term suspension culture, rh GM-CSF enhanced the expression of CD 29- and CD 11b-adhesion molecules on peripheral blast cells. In summary, this case represents a fatal spleen rupture occurring during rh GM-CSF priming and induction chemotherapy for acute monocytic leukemia. Although the etiology of this spleen rupture remains uncertain, in view of our data we suggest special caution, when further testing this therapy protocol in acute leukemias with monocytic subtype and high peripheral blast cell counts. ( info) |
| Atraumatic splenic ruptures in the course of infectious diseases are rare but have been reported. Various germs of viruses can be at the origin of such rupture. The more often quoted viral disease is infectious mononucleosis. The more frequently involved bacteria are Streptococcus non pneumoniae, pseudomonas, staphylococci and clostridium. Rupture mechanism is not clearly elucidated; it can be connected with sepsis diffusion at spleen level via haematogenic way and consequently splenomegaly. splenic rupture following septicaemia does not always entail major splenomegaly nor abscess formation but the attack of the splenic tissue itself is sometimes sufficient to bring about the rupture. The present case of atraumatic splenic rupture on spleen sepsis, no abscess, starting from a pulmonar infection with streptococcus pneumoniae is, to our knowledge, the first case reported in literature. ( info) |
364/417. Delayed splenic rupture in a drug addict. We present the case of a drug addict who was admitted with abdominal pain but gave no history of trauma. He subsequently left the hospital against medical advice, only to be readmitted a few days later with persistent abdominal pain. He was found to have splenic rupture. This case emphasizes the importance of ruling out intra-abdominal trauma in any drug addict presenting with acute abdomen. ( info) |
365/417. Peliosis of the spleen: a rare cause of spontaneous splenic rupture with surgical implications. Peliosis is a rare entity, formerly seen almost exclusively at autopsy, which most commonly involves the liver and less frequently the spleen. We present the sixth reported case of splenic peliosis discovered at surgical exploration and discuss the relevant findings and background of this condition, which may become an important issue for the surgeon. ( info) |
366/417. Operative trauma to the spleen. A patient is discussed in whom splenic rupture followed an elective uncomplicated cholecystectomy by two weeks. There was no known direct operative or postoperative trauma to the spleen and the spleen was microscopically normal with no evidence of organizing hematoma. Possible mechanisms of operative splenic injury to the spleen are reviewed and the importance of recognition of this entity by surgeons is emphasized. ( info) |
367/417. Gastric rupture as a result of blunt trauma. Six patients with gastric rupture secondary to blunt abdominal trauma are presented in detail. The salient features of each case are briefly discussed, along with a further analysis of the review by Yajko and colleagues. The aggressive operative treatment of these patients is emphasized along with the vigorous attention that must be given to postoperative intra-abdominal sepsis caused by the initial contamination leading to morbidity and mortality. ( info) |
368/417. Splenic injury due to indirect torsion. A patient with subcapsular rupture of the spleen in association with indirect torsion trauma is reported. The spleen was surrounded by bands and adherent organs. The injury was considered to have been caused by a stretched band. In patients with hemoperitoneum, celiac angiography is advocated for diagnosis when immediate surgery is not indicated. ( info) |
369/417. Delayed rupture of the spleen 5 1/2 years after conservative management of traumatic splenic injury. A patient in whom spontaneous rupture of the spleen occurred 5 1/2 years following conservative management of splenic trauma is reported. The problem of late splenic rupture following splenic conservation therapy is discussed. ( info) |
| Due to its location in the abdominal cavity, the spleen is a prime target for damage from blunt injury. splenic rupture can occur immediately or it can be delayed up to 14 days following injury. A case report is presented involving a patient who sustained a ruptured spleen 2 weeks following an altercation. ( info) |