Pathological rupture of the normal spleen: Review with the literature

Abstract

Introduction: Atraumatic spontaneous rupture of the spleen is an uncommon but fatal condition that may coexist with other disease. Our case was presented with obvious CT findings of a spontaneous rupture of the spleen.

Presentation of the case: A 75-year-old woman admitted to the emergency service with abdominal pain. Although there was no evident splenomegaly in the abdominal CT examination, the patient was diagnosed with diffuse large B-cell lymphoma, and densities in harmony with the free air were detected in the spleen and the abdomen.

Discussion: It is clear that a healthy spleen does not rupture without marked trauma; hence, a doctor must carefully investigate the underlying pathology. Splenomegaly, the infiltration of the spleen and the capsule and consequently a splenic infarct and hemorrhage were set forth as the causes of the rupture of the spleen in lymphomas. However, our case had no splenomegaly or splenic involvement of lymphoma in the pathological examination. Even in the absence of splenomegaly, rupture may develop for such reasons as inflammation and embolism. Splenic infarcts are also in the developmental mechanism.

Conclusion: Although atraumatic rupture of the spleen is not prevalent, it is a case which must be considered in an acute abdominal pain as it has highly fatal outcomes without CT exam.

Keywords: Abdominal pain; CT; Rupture; Spleen.

Fig. 1

The intra-abdominal free air is shown (arrow).

Fig. 2

The intra-splenic air densities (arrow) are shown.

Fig. 3

The intra-splenic air densities are shown at the cross-section passing through a lower level.

Fig. 4

A- The macroscopic image of the spleen. B- The gap into which air entered between the capsule and the parenchyma is shown.