Hajri Amal, Yaqine Karim, El Massi Salaheddine, Errguibi Driss, Boufettal Rachid, El Jai Saad Rifki, Chehab Farid
Departement of General Surgery, University Hospital Centre Ibn Rochd, Casablanca, Morocco.
Faculty of Medecine and Pharmacy, Hassan II University, Casablanca, Morocco.
Ann Med Surg (Lond). 2021 May 5;65:102286. doi: 10.1016/j.amsu.2021.102286. eCollection 2021 May.
Spontaneous rupture of the spleen (SPR) is a rare and severe affection, difficult to diagnose, with multiple causes such as: Infectious and hematologic affections which represent more than half of the cases. Among this subset of patients, acute myeloid leukemia is one of the causes.
A 48-year-old man undergoing chemotherapy for acute myeloid leukemia presented with acute intense abdominal pain. Computed tomography showed Abdominal CT scan showed a splenic rupture with abundant hemoperitoneum and bilateral pleural effusion. The patient presented hemodynamic instability and was immediately operated, splenectomy were performed.
Spontaneous rupture of the spleen usually presents as a severe abdominal syndrome, which may accompany non-specific symptoms.Two signs are suggestive of splenic rupture: Kehr's sign (left diaphragmatic irritation resulting in referred pain to the left shoulder) and Balance's sign (palpable tender mass in the left upper quadrant. Diagnostic methods of choice are computed tomography andultrasound. The prognosis is depending on the quality of care and the nature of the etiology. Splenectomy remains the cornerstone of the treatment of splenic rupture. It is important to include splenic rupture as a differential diagnosis for acute abdominal pain, especially in patients with hematologic malignancy, since early recognition and treatment increase patient survival and improve the prognosis.
Even if spontaneous splenic rupture is rare, every clinician should have in mind the reflex to think of it, especially in patients with hematologic malignancies.
自发性脾破裂（SPR）是一种罕见且严重的病症，难以诊断，病因多样，如：感染性和血液学病症，这些病因占病例的一半以上。在这类患者中，急性髓系白血病是病因之一。
一名48岁因急性髓系白血病接受化疗的男性患者出现急性剧烈腹痛。计算机断层扫描显示腹部CT扫描显示脾破裂伴大量腹腔积血和双侧胸腔积液。患者出现血流动力学不稳定，立即接受手术，进行了脾切除术。
自发性脾破裂通常表现为严重的腹部综合征，可能伴有非特异性症状。有两个体征提示脾破裂：凯尔氏征（左膈刺激导致左肩牵涉痛）和巴伦斯征（左上象限可触及压痛肿块）。首选的诊断方法是计算机断层扫描和超声检查。预后取决于护理质量和病因性质。脾切除术仍然是脾破裂治疗的基石。将脾破裂作为急性腹痛的鉴别诊断很重要，尤其是在血液系统恶性肿瘤患者中，因为早期识别和治疗可提高患者生存率并改善预后。
即使自发性脾破裂很少见，但每位临床医生都应牢记考虑到这种情况，尤其是在血液系统恶性肿瘤患者中。
