Spontaneous Splenic Rupture Treated with Splenectomy

: Report of a Case and a Review of Atraumatic Splenic Ruptures in the Japanese Literature

Abstract

A 53-year-old man visited our hospital with sudden left upper abdominal pain and no history of trauma. Slight elevation of serum liver enzyme levels alone was observed in the blood biochemistry. Enhanced abdominal CT showed intra-abdominal fluid collection with a rupture at the lower pole of the spleen and extravasation of the contrast medium. Splenic arteriography revealed the presence of small aneurysms in the spleen. Based on the patient's medical record and normal findings of both hematology and imaging, a splenectomy was performed under the diagnosis of atraumatic splenic rupture (ASR). On pathological examination, the presence of pseudoaneurysms in the spleen accompanied with disruption of the arterial media was confirmed without neoplasm or inflammation. The final diagnosis was, therefore, a spontaneous splenic rupture. The patient was discharged on day 9 after surgery without complications. The small arterial disorders seen in this patient may have the potential to induce an atraumatic splenic rupture in cases without any clinical background. We herein report on this rare case of spontaneous splenic rupture with a Japanese literature review.