Atraumatic splenic rupture in a peritoneal dialysis patient

Abstract

Splenic hemorrhage is a potentially life-threatening complication usually occurring after blunt trauma to the abdomen. Atraumatic splenic rupture (ASR) is an uncommon condition, and mostly results from pathology affecting the spleen, such as tumor infiltration or infection. Here, we report a case of atraumatic rupture of a normal spleen in a patient undergoing peritoneal dialysis, and review similar cases in the literature. The case involved a 58-year-old man with nephrotic syndrome who had been undergoing peritoneal dialysis for 1 year. He presented to the hospital with abdominal pain, nausea, and blood-stained dialysate. Laboratory data revealed severe anemia, with a hemoglobin of 4.3 g/dL. An abdominal computed tomography (CT) scan demonstrated a high-density area around the spleen and malposition of the catheter. Laparoscopy revealed large amounts of coagulated blood surrounding the spleen. The patient was diagnosed with atraumatic splenic bleeding. He improved with bed rest and blood transfusion, and could continue with peritoneal dialysis. It was considered that the etiology of bleeding was directly from the spleen. However, due to the temporary malposition of the peritoneal catheter, catheter-induced splenic trauma could not be ruled out. ASR is a rare entity that needs a high index of suspicion for diagnosis. Using CT scanning and peritoneal fluid analysis, these modalities may assist in the diagnosis. Emergency intervention is required upon definitive diagnosis. Increased awareness of ASR can enhance the early diagnosis and effective treatment.

Keywords: Atraumatic splenic rupture; Chronic renal failure; Peritoneal dialysis.

Fig. 1

Displacement of the catheter tip and splenic rupture on imaging studies. a Radiograph of the abdomen captured catheter tip migration to the left hypochondrium (black arrow head). b Non-contrast CT scan revealed a perisplenic hematoma (white arrow) associated with a moderate amount of high density fluid in the peritoneal cavity. c Contrast CT scan showed a hypodense area consistent with lacerations in the spleen (white arrow head)

Fig. 2

Exploratory laparoscopy revealing a large perisplenic hematoma without signs of active bleeding. The surface of the spleen was not investigated since it was covered by the blood clots