Diagnosis and Treatment of Atraumatic Splenic Rupture: Experience of 8 Cases

Abstract

Atraumatic splenic rupture (ASR) is rare but life threatening. In this study, we retrospectively described our experience on the diagnosis and treatment of 8 patients (male: 6; female: 2; mean age: 49.6) with ASR. ASR accounted for 3.2% (8/251) of the splenic ruptures. The clinical presentation of ASR was similar to traumatic splenic rupture (TSR). The sensitivity of ultrasound and contrast-enhanced computed tomography (CECT) in ASR diagnosis was 57.1% and 85.7%, respectively. According to the classification of the American Association for the Surgery of Trauma (AAST), 2 cases were classified as grade II splenic ruptures, 4 cases were classified as grade III ruptures, 1 case was classified as grade IV rupture, and 1 case was not classified. All the spleens became swollen, and hematomas were observed in 6 patients. Total splenectomy was recommended in most cases. At least 62.5% (5/8) of the patients with 7 etiological factors belonged to "atraumatic-pathological splenic rupture." Local inflammation and cancer were the most common etiological factors.

Figure 1

CT scan of patient no. 5. (a) Axial section of the CT scan showed an infarction of the lower pole of the spleen on admission. (b) Axial section of the CT scan showed a colon tumor of the splenic flexure.

Figure 2

CT scan of patient no. 4. (a) Axial section of the CT scan showed a hematoma in the lower pole and lateral spleen area combined with the enlargement of the body and tail of the pancreas and free fluid around the liver and spleen. (b) Coronal section of the CT scan showed an obstruction of the small intestine.