Zhou Jason, Wilhide Matthew, Howard Katherine, Solom Abigail, Anandalwar Seema, Clark Jaclyn, Olafson Samantha
University of Maryland School of Medicine, 685 West Baltimore Street, Baltimore, MD 21201, United States of America.
Department of Surgery, R Adam Cowley Shock Trauma Center, University of Maryland Medical Center, 22 South Green Street, Baltimore, MD 21201, United States of America.
Trauma Case Rep. 2024 Sep 14;54:101108. doi: 10.1016/j.tcr.2024.101108. eCollection 2024 Dec.
Malignancy is a rare etiology of splenic rupture, with most documented cases resulting from hematologic cancers. There have been very few reports of splenic rupture resulting from invasion or metastasis of adenocarcinoma and even fewer reports resulting from specifically pancreatic adenocarcinoma. In this case report, we outline the clinical course of a 60-year-old male with splenic rupture and hemoperitoneum following a ground level fall who was transferred to the Shock Trauma Center (STC) from a local emergency department. Outside of the ruptured spleen, no other traumatic injuries were found on examination or imaging. Due to the initial concern for traumatic etiology, exploratory laparotomy was performed with splenectomy and distal pancreatectomy. Postoperative pathology results revealed pancreatic adenocarcinoma with splenic invasion staged pT3N0. This report provides a novel example of splenic rupture in the background of locally advanced pancreatic adenocarcinoma and further solidifies the importance of maintaining a broad differential in cases of seemingly innocuous trauma.
恶性肿瘤是脾破裂的罕见病因，大多数有记录的病例是由血液系统癌症引起的。腺癌侵犯或转移导致脾破裂的报道非常少，而由胰腺腺癌特异性导致的脾破裂报道更少。在本病例报告中，我们概述了一名60岁男性的临床过程，该男性因平地摔倒后出现脾破裂和腹腔积血，从当地急诊科转入休克创伤中心（STC）。检查和影像学检查未发现除破裂脾脏外的其他创伤性损伤。由于最初考虑为创伤性病因，遂行剖腹探查术，进行脾切除术和胰体尾切除术。术后病理结果显示为胰腺腺癌侵犯脾脏，分期为pT3N0。本报告提供了一个局部晚期胰腺腺癌背景下脾破裂的新案例，并进一步强化了在看似无害的创伤病例中保持广泛鉴别诊断的重要性。
