2016 Volume 49 Issue 9 Pages 605-609
A 56-year-old male was started on peritoneal dialysis for end-stage renal failure due to chronic glomerulonephritis 4 years ago. He had been on antiplatelet medication for retinal artery branch occlusion for the previous 6 months. While riding a bus, he developed sudden nausea, vomiting, and left hypochondriac pain. As bloody peritoneal dialysate was noted when his bag was changed, he was examined at our hospital. Plain abdominal computed tomography (CT) revealed a hematoma around the spleen, and the bloody peritoneal dialysate was attributed to splenic rupture. As the patient had no history of trauma, and no apparent infectious disease, malignant tumor, or other underlying condition was detected, he was diagnosed with spontaneous rupture of the spleen. He was admitted immediately. The antiplatelet medication was discontinued, and his condition was monitored conservatively. The bloody peritoneal dialysate gradually improved, and as plain CT revealed that the hematoma had regressed, he was discharged from hospital. Non-traumatic splenic rupture can lead to hemorrhagic shock, and splenectomy might be required in some cases. If unexplained bloody peritoneal dialysate is observed in patients on peritoneal dialysis, non-traumatic splenic rupture must be excluded as soon as possible. If unexplained bloody peritoneal dialysate persists in peritoneal dialysis patients, it is important to perform imaging as quickly as possible to exclude hemorrhaging due to splenic rupture.
