Ayoub Madani, Mabrouk Mohamed Yassine, Abdelouahab Hajar, Kamaoui Imane, Achraf Miry, Hamaz Siham, Serraj Khalid, Rachid Jabi, Mohamed Bouziane
Department of General Surgery, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Laboratory of Anatomy, Microsurgery and Surgery, Experimental and Medical Simulation (LAMCESM), Mohammed Ist University, Oujda, Morocco.
Department of General Surgery, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Laboratory of Anatomy, Microsurgery and Surgery, Experimental and Medical Simulation (LAMCESM), Mohammed Ist University, Oujda, Morocco.
Int J Surg Case Rep. 2022 Jul;96:107315. doi: 10.1016/j.ijscr.2022.107315. Epub 2022 Jun 16.
Spleen Spontaneous Rupture SRS is a rare phenomenon in which the spleen ruptures without associated trauma. This pathology is rarely caused by Chronic Lymphocytic Leukemia.
We present a case of a 59-year-old male patient with chronic Lymphocytic Leukemia, who was admitted with an acute abdomen whose clinical and paraclinical examinations revealed a spleen spontaneous rupture. The treatment consisted of a splenectomy.
Spontaneous spleen rupture was first described by Rokitansky in 1861 and mentioned in many cases since, the common causes of non-traumatic Splenic rupture include myeloproliferative diseases, vasculitis, and infections. However, Chronic Lymphocytic Leukemia (CLL) remains an obscure cause of splenic rupture that requires unique attention. The diagnosis of splenic rupture should be considered in all patients with hematologic malignancies presenting with abrupt onset of abdominal pain, hemodynamic instability, or acute anemia. The choice between conservative treatment and splenectomy depends on different variables: the etiology of the SRS, the hemodynamic stability, the amount of packed red blood cells transfused. Thus, an interventional approach can be advocated for a spontaneous splenic rupture over nonoperative management. Splenic embolization can provide patients with the advantages of both operative splenectomy and conservative management. The mortality rate from SRS is 12.2 %. Neoplastic pathologies were most significantly associated with fatal outcomes.
The high mortality rate seems to be mainly related to the delayed diagnosis and/or the severity of the underlying pathology. Given its seriousness, it requires a rapid diagnosis and adapted management.
脾自发性破裂（SRS）是一种罕见现象，即脾脏在无相关创伤的情况下发生破裂。这种病理情况很少由慢性淋巴细胞白血病引起。
我们报告一例59岁慢性淋巴细胞白血病男性患者，因急腹症入院，临床及辅助检查显示为脾自发性破裂。治疗方法为脾切除术。
脾自发性破裂最早由罗基坦斯基在1861年描述，此后在许多病例中都有提及，非创伤性脾破裂的常见原因包括骨髓增殖性疾病、血管炎和感染。然而，慢性淋巴细胞白血病（CLL）仍然是脾破裂的一个不明确病因，需要特别关注。所有出现腹痛突然发作、血流动力学不稳定或急性贫血的血液系统恶性肿瘤患者都应考虑脾破裂的诊断。保守治疗和脾切除术之间的选择取决于不同变量：SRS的病因、血流动力学稳定性、输注的红细胞压积量。因此，对于自发性脾破裂，提倡采用介入性方法而非非手术治疗。脾栓塞可为患者提供手术脾切除术和保守治疗的双重优势。SRS的死亡率为12.2%。肿瘤性病变与致命结局的相关性最为显著。
高死亡率似乎主要与诊断延迟和/或潜在病理状况的严重程度有关。鉴于其严重性，需要快速诊断和适当的治疗。
