Atraumatic splenic rupture was attributed to intra-cystic haemorrhage and hypersplenism in a patient with cirrhosis and portal hypertension: A case report

Abstract

Liver cirrhosis with splenomegaly and portal hypertension has been described in the medical literature as increasing the risk of splenic rupture. We report a case of atraumatic splenic rupture in a male with liver cirrhosis associated with splenomegaly, which was further complicated by hypersplenism and intra-cystic haemorrhage in the spleen. The 56-year-old man was hospitalized because of sudden onset of intermittent pain in the left quadrant abdomen with no history of trauma. Upon admission, the patient presented no fever, palpable abdominal tenderness, splenomegaly, and hypersplenism. Enhanced computed tomography revealed a splenic subcapsular haematoma connected to a cystic mass located at the splenic hilum and free fluid in the abdomen, which is indicative of splenic rupture. The patient underwent immediate laparotomy and splenectomy followed by proper management. Post-surgery diagnostic microscopy indicated liver steatosis, perivenular fibrosis, and regenerative nodules, which are suggestive of cirrhosis. The patient was discharged from the hospital with an uneventful recovery.

Keywords: Atraumatic splenic rupture; cirrhosis; hypersplenism; intra-cystic haemorrhage; splenomegaly.

Figure 1.

Abdominal computed tomography views of the patient. (Left) Arrow A: a cystic mass located at the splenic hilum and intra-cystic haemorrhage; Arrow B: splenic laceration; Arrow C: splenic haematoma. (Right) Intra-cystic haemorrhage leading to subcapsular haematoma.

Figure 2.

Pathohistological views of liver and spleen tissues from the patient. (a) The liver shows macrovesicular steatosis, H&E staining, objective, 10×; (b) fibrous bands subdividing liver into regenerative nodules, Trichrome staining, indicative of cirrhosis, objective, 10×; (c) intra-cystic haemorrhage in the spleen, H&E staining, objective, 4×; and (d) the spleen shows congestion and dilation of sinusoids, active germinal centres and increased numbers of macrophages, H&E staining, objective, 10×.