Abstract
We report a case of spontaneous splenic rupture in a 71-year-old man receiving maintenance hemodialysis. Hemodialysis was started 5 months earlier due to chronic renal failure caused by diabetic nephropathy. Medical history included non-Hodgkin lymphoma and surgery for colon cancer, along with the presence of hypothyroidism, C virus-induced hepatitis and arteriosclerosis obliterans. Before admission, the patient had been given heparin at each hemodialysis session. Erythropoietin and antiplatelet therapy had also been administered. He developed mild splenomegaly after chemotherapy for malignant lymphoma, but had not shown massive splenomegaly at that time. He arrived at the emergency room of Nagoya Memorial Hospital complaining of partial numbness in both legs and abdominal fullness. He had no history of trauma. Blood pressure was 85/47 mmHg, heart rate was 116 beats/min and hemoglobin was 6.4 g/dL. Computed tomography showed rupture of an enlarged spleen with hematoma. Blood transfusion was provided and he was closely observed in the Intensive Care Unit. After 3 days, since anemia progressed rapidly, emergent splenectomy was performed. A total of 1,100 mL of hemorrhage and blood clots were removed from the abdominal cavity. The enlarged spleen had ruptured near the hilum. Postoperatively, the patient recovered and was discharged on hospital day 28. Histological studies showed congestion of the spleen, but there were no tumorous lesions, broken vessels, amyloid angiopathy or peliosis lesion. Spontaneous splenic rupture was thus diagnosed. Spontaneous splenic rupture is a rare but potentially life-threatening condition. Patients on hemodialysis receiving anti-coagulants and frequent anti-platelet therapy are at particular risk. This case suggests that early diagnosis and therapy for spontaneous splenic rupture is very important.
