Cocaine-associated hemoperitoneum following atraumatic splenic rupture: a case report and literature review

Abstract

Introduction: Splenic hematoma or rupture of the spleen is rare in the absence of trauma. This case report with a brief review of the literature is intended to raise awareness of splenic bleeding as an etiology of abdominal pain; it highlights the importance of a detailed social history.

Presentation of case: This report of an otherwise healthy 42-year old man details hemoperitoneum with splenic rupture as a cause for hemorrhage following cocaine use. The patient was managed non-operatively in the surgical intensive care unit. He did not require transfusion and was discharged home on hospital day four with close follow-up.

Discussion: While splenic pathology associated with cocaine use has been described, this case illustrates a novel report of cocaine-associated splenic hemorrhage. A plausible mechanism is transient vasospasm with subsequent bleeding into the infarcted area.

Conclusion: Although uncommon, atraumatic splenic rupture should be recognized early because it is potentially fatal. This case is the first to describe hemoperitoneum of splenic etiology following cocaine use.

Figure 1

Axial, contrast-enhanced CT image demonstrates moderate hemoperitoneum in left upper quadrant centered around the spleen.

Figure 2

Sagittal, contrast-enhanced CT image demonstrates perisplenic hematoma.

Figure 3

Axial, contrast-enhanced CT image of the pelvis demonstrates large hemoperitoneum.

Figure 4

2D gray scale ultrasound image demonstrates small degree of subcapsular splenic hematoma.