Gavriilidis Paschalis, Xanthakos Pantelis
Department of Surgery, General Hospital of Syros, "Vardakeio and Proïo", Hermoupolis, Syros, Greece.
Br J Hosp Med (Lond). 2024 Nov 30;85(11):1-9. doi: 10.12968/hmed.2024.0494. Epub 2024 Nov 25.
Atraumatic splenic rupture is a very rare and potentially life-threatening event usually associated with underlying pathological conditions. Splenic rupture in infectious mononucleosis occurs only in 0.1%-0.5% of patients. The aim of the present study was to publish a case report of the atraumatic splenic rupture and to present a mini-review of the international literature. A 30-year-old man of mixed races (Caucasian and African) diagnosed with acute cholecystitis was referred by a rural doctor to a secondary district hospital. His past medical and family history was unremarkable. He did not report any allergies. On arrival, his vital signs were stable. However, laboratory examinations demonstrated: white blood cells 26 × 10/μL (4-11), neutrophils 38.8% (35%-72%), lymphocytes 58% (20%-45%), red blood cells 3.59 M/μL (0-0.6), haemoglobin 10.9 g/dL (13.5-17.5), haematocrit 33.4% (40%-54%), platelets 11.5 fL (6.5-11), prothrombin time 13.2 s (9.4-12.5), glucose 70 mg/dL (74-107), sodium 135 mmol/L (137-146), calcium 7.6 mg/dL (8.8-106), serum glutamic-oxaloacetic transaminase 426 U/L (10-45), serum glutamate pyruvate transaminase 530 U/L (7-45), gamma glutamyl transferase 151 U/L (7-49), total albumins 5.3 g/dL (6.6-8.3), C-reactive protein 235 mg/L (<5), and Epstein-Barr virus 15.50 S/CO (0-1.0). In addition, computed tomography determined hepatosplenomegaly, haemoperitoneum, and spleen rupture. Physical examination revealed abdominal rigidity, left shoulder tip pain, shortened capillary refill time, and neck lymphadenopathy. The patient underwent expeditious total splenectomy, postoperative period was uneventful and he was discharged on the sixth postoperative day. He was scheduled to undergo the post-splenectomy vaccinations and regular follow-ups with his general practitioner abroad. In patients without a history of trauma, spontaneous splenic rupture should be considered in the differential diagnosis if patients have complaints of abdominal and left shoulder tip pain, and laboratory results indicate low haemoglobin and haematocrit levels.
非创伤性脾破裂是一种非常罕见且可能危及生命的事件，通常与潜在的病理状况相关。传染性单核细胞增多症中的脾破裂仅发生在0.1%-0.5%的患者中。本研究的目的是发表一例非创伤性脾破裂的病例报告，并对国际文献进行简要综述。一名30岁的混血男性（白种人和非洲人）被诊断为急性胆囊炎，由一名乡村医生转诊至二级地区医院。他既往的病史和家族史均无异常。他未报告任何过敏史。入院时，他的生命体征稳定。然而，实验室检查结果显示：白细胞26×10/μL（4-11），中性粒细胞38.8%（35%-72%），淋巴细胞58%（20%-45%），红细胞3.59M/μL（0-0.6），血红蛋白10.9g/dL（13.5-17.5），血细胞比容33.4%（40%-54%），血小板11.5fL（6.5-11），凝血酶原时间13.2秒（9.4-12.5），葡萄糖70mg/dL（74-107），钠135mmol/L（137-146），钙7.6mg/dL（8.8-106），血清谷草转氨酶426U/L（10-45），血清谷丙转氨酶530U/L（7-45），γ-谷氨酰转移酶151U/L（7-49），总白蛋白5.3g/dL（6.6-8.3），C反应蛋白235mg/L（<5），以及EB病毒15.50S/CO（0-1.0）。此外，计算机断层扫描显示肝脾肿大、腹腔积血和脾破裂。体格检查发现腹部强直、左肩尖疼痛、毛细血管再充盈时间缩短和颈部淋巴结病。该患者迅速接受了全脾切除术，术后恢复顺利，术后第六天出院。他计划接受脾切除术后的疫苗接种，并在国外的全科医生处定期随访。对于没有创伤史的患者，如果患者有腹部和左肩尖疼痛的主诉，且实验室结果显示血红蛋白和血细胞比容水平较低，则在鉴别诊断中应考虑自发性脾破裂。
