%0 Journal Article
%T Massive Splenic Rupture ¨C An Unusual Presentation - Massive Splenic Rupture ¨C An Unusual Presentation - Open Access Pub
%A Shiva Seetahal
%J OAP | Home | Journal of Spleen And Liver Research | Open Access Pub
%D 2018
%X DOI 10.14302/issn.2578-2371.jslr-16-1068  A 61 year old Caucasian male, visiting from the UK, presented to the Emergency Room (ER) complaining of a chronic cough for 2 weeks and new-onset dizziness. The cough was non-productive but recalcitrant to antitussives. His dizziness was exacerbated with exertion and associated with palpitations and sweating. While in the ER, he also started experiencing generalized abdominal pain. His medical history included hypothyroidism and hypertension, both adequately controlled with medications. His annual physical and blood work, done 3 months prior in the UK, was unremarkable by his account. Vitals signs included an initial blood pressure of 109/58 mmHg and sinus tachycardia. Physical exam revealed an asymmetrically distended abdomen with rebound tenderness and splenomegaly, and decreased breath sounds in the left lung base. Hemoglobin on admission was 10.9 g/dl which dropped to 9.1 g/dl; his white blood cell count (WBC) was 139 (x 109 /L). Although the patient and his wife were visiting the area to indulge in the local theme parks, he denied participating in any of the rides owing to malaise from his cough. He also denied any trauma to the torso area in recent times. A plain abdominopelvic CT showed massive splenomegaly with high attenuation areas suspicious for hematoma, as well as free fluid in the abdomen (Figure 1). The patient was immediately started on a transfusion of packed red blood cells and taken emergently to the operating room. A laparotomy was performed and the patient was found to have a massive, ruptured spleen with 1500 mls of frank blood in the peritoneal cavity. Splenectomy and abdominal washout were done. The spleen measured 21 x 19 x 10 cm and weighed 2870 grams. It is shown below (Figure 2). Figure 1. CT image of the abdomen showing the enlarged spleen. The arrows point to areas of higher attenuation suspicious for hematoma Figure 2. Spleen following removal ¨C medial and hilar aspect shown. Arrow points to area of rupture. 1. Postoperatively, the patient recovered well and was discharged 4 days later. Pathology of the spleen showed a predominance of maturing myeloid cells and was consistent with chronic myelomoncytic leukemia (CML). CML is disorder of the bone marrow`s stem cells that results in a proliferation of granulocytes in various stages of maturity. The incidence is roughly 1.5 in 100,000 and accounts for 10-15% of all leukemia types. It is more common in males and has a median age of diagnosis of 65 years, being extremely rare in children. It is associated with the chromosomal
%U https://www.openaccesspub.org/jslr/article/302