Chandra Abhishek, Navarro Sergio M, Killeen Trevor F, Nemanich George, Harmon James V
Department of Surgery, University of Minnesota Medical School, Minneapolis, MN 55414, United States.
Department of Surgery, University of Minnesota Medical School, Minneapolis, MN 55414, United States.
Int J Surg Case Rep. 2023 Sep;110:108676. doi: 10.1016/j.ijscr.2023.108676. Epub 2023 Aug 19.
Isolated splenic peliosis is an extremely rare condition. The associations of splenic peliosis with various infections, medications, and conditions have unclear significance. We present three patients from the past twenty years with spontaneous splenic rupture due to peliosis, two of whom had hematologic malignancy, to draw attention to a possible correlation.
A 31-year-old male with essential thrombocytopenia and antiphospholipid-antibody syndrome presented with worsening abdominal pain and hypotension. The patient denied any trauma. Computed-tomography demonstrated hemoperitoneum and splenic rupture with innumerable blood-filled splenic cysts. An uncomplicated emergency open splenectomy was performed with shed-blood reinfusion. The patient was discharged on postoperative day five. The patient developed acute myelogenous leukemia and died six years later. A 44-year-old otherwise healthy male presented with left upper-quadrant and shoulder pain without reported trauma. Computed-tomography (CT) imaging revealed splenomegaly, multiple splenic cystic lesions, and free intraperitoneal blood. A laparoscopic splenectomy, complicated by a pancreatic leak that was managed with a drain, was performed. The patient was discharged on postoperative day three and was well at 37 months follow-up. A 78-year-old male with splenomegaly and chronic anemia on warfarin for atrial fibrillation presented in shock with a distended abdomen after falling from a standing height. The patient was resuscitated with two units of packed red blood cells and underwent emergent abdominal exploration. The spleen was ruptured. An open splenectomy was performed and four liters of intraperitoneal blood were evacuated. Pathology confirmed splenic peliosis and historic diffuse large B-cell lymphoma. The patient had an excellent response to chemotherapy but died 12 years later.
Splenic peliosis is a rare vascular phenomenon of unclear etiology. Several toxic and pharmaceutical agents have been associated with spontaneous splenic rupture in patients with peliosis. There are also a number of reported patients who were noted to have hematologic disorders, suggestive of a potential association to the pathophysiology of peliosis.
Based on our clinical experience and focused literature review, it appears likely that there is a relationship between splenic peliosis and hematologic malignancy.
孤立性脾紫癜是一种极为罕见的病症。脾紫癜与各种感染、药物及病症之间的关联，其意义尚不清楚。我们呈现过去二十年间因紫癜导致自发性脾破裂的三名患者，其中两名患有血液系统恶性肿瘤，以引起对可能存在的相关性的关注。
一名31岁患有原发性血小板增多症和抗磷脂抗体综合征的男性，出现腹痛加重和低血压症状。患者否认有任何外伤史。计算机断层扫描显示腹腔积血和脾破裂，伴有无数充满血液的脾囊肿。进行了无并发症的急诊开放性脾切除术，并回输了流出的血液。患者于术后第五天出院。该患者后来患上急性髓系白血病，并在六年后死亡。一名44岁身体健康的男性，出现左上腹和肩部疼痛，无外伤史报告。计算机断层扫描（CT）成像显示脾肿大、多个脾囊性病变以及腹腔内游离血液。实施了腹腔镜脾切除术，术后出现胰漏，通过放置引流管进行处理。患者于术后第三天出院，在37个月的随访中情况良好。一名78岁患有脾肿大和慢性贫血且因房颤服用华法林的男性，从站立高度跌倒后出现休克，腹部膨隆。患者输注两单位浓缩红细胞进行复苏，并接受了急诊腹部探查。脾脏破裂。实施了开放性脾切除术，排出了四升腹腔内积血。病理检查证实为脾紫癜以及既往有弥漫性大B细胞淋巴瘤。该患者对化疗反应良好，但12年后死亡。
脾紫癜是一种病因不明的罕见血管现象。多种毒性和药物制剂与患有紫癜的患者自发性脾破裂有关。也有许多报告的患者被发现患有血液系统疾病，提示可能与紫癜的病理生理学存在潜在关联。
基于我们的临床经验和针对性的文献综述，脾紫癜与血液系统恶性肿瘤之间似乎存在关联。
