Lin Jia-Li, Lin Can, Wang Han-Lu, Wu Shao-Jie, Tang Yi, Yang Chang Shun, Luo Jie-Wei, Chi Wu, Fang Zhu-Ting
Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China.
Department of Radiology, Fuzhou Second Hospital, Fuzhou, China.
Front Cardiovasc Med. 2022 Jun 3;9:925711. doi: 10.3389/fcvm.2022.925711. eCollection 2022.
Spontaneous splenic rupture (SSR) is a rare, often life-threatening, acute abdominal injury that requires immediate diagnosis and early treatment. SSR is mainly treated surgically or conservatively. A few cases of interventional embolization for SSRs have been reported.
A 30-year-old male patient complaining mainly of left upper abdominal pain underwent emergency abdominal computed tomography (CT) and showed enlargement of the spleen with a massive mixed-density shadow approximately 10.0 × 8.0 × 12.5 cm in size. The boundary was unclear and showed obvious progressive enhancement. Considering the intrasplenic tumor lesions with rupture and hemorrhage, the possibility of vascular tumors was high, with intraperitoneal blood and fluid accumulation. Digital subtraction angiography of the splenic arteriography and embolization of the ruptured splenic artery branches were performed. Postoperative hemoglobin progressively decreased, inflammatory indicators, such as white blood cell counts, procalcitonin (PCT), and C-reactive protein (CRP) were significantly increased, and 2 days after embolization, the patient developed severe hypoxemia, shock, pulmonary edema, and acute respiratory distress syndrome. CT re-examination 9 days after embolization showed reduced lesion absorption. After stabilization of the condition, splenectomy was performed, and postoperative platelet count increase, anticoagulant improvement, and discharge were observed. Postoperative pathological examination revealed extensive hemorrhage and necrosis, vascular tissue with abnormal hyperplasia in the surrounding area, vascular tissue in the bleeding area and outer wall (elastic fiber staining +), and local myofibroblast hyperplasia. Immunohistochemistry showed actin (SM +) and Ki67 (10% +).
SSR caused by splenic hemangioma is rare, and the choice between surgical treatment or splenic artery embolization remains dependent on the patient's hemodynamic stability and imaging findings.
自发性脾破裂（SSR）是一种罕见的、常危及生命的急性腹部损伤，需要立即诊断和早期治疗。SSR主要通过手术或保守治疗。已有少数关于SSR介入栓塞治疗的病例报道。
一名主要抱怨左上腹疼痛的30岁男性患者接受了腹部急诊计算机断层扫描（CT），结果显示脾脏肿大，有一个大小约为10.0×8.0×12.5 cm的巨大混合密度阴影。边界不清，呈明显渐进性强化。考虑为脾内肿瘤性病变破裂出血，血管肿瘤可能性大，伴有腹腔内积血和积液。进行了脾动脉数字减影血管造影及破裂脾动脉分支栓塞术。术后血红蛋白逐渐下降，白细胞计数、降钙素原（PCT）和C反应蛋白（CRP）等炎症指标显著升高，栓塞术后2天，患者出现严重低氧血症、休克、肺水肿和急性呼吸窘迫综合征。栓塞术后9天CT复查显示病变吸收减少。病情稳定后行脾切除术，术后观察到血小板计数升高、凝血改善并出院。术后病理检查显示广泛出血和坏死，周围区域血管组织异常增生，出血区域及外壁有血管组织（弹性纤维染色阳性），局部肌成纤维细胞增生。免疫组化显示肌动蛋白（SM阳性）和Ki67（10%阳性）。
脾血管瘤引起的SSR罕见，手术治疗或脾动脉栓塞术的选择仍取决于患者的血流动力学稳定性和影像学表现。
