Splenic peliosis with spontaneous splenic rupture: report of two cases

A previously well twenty-six year old woman presented with abdominal pain following a trivial episode of coughing. A diagnosis of spontaneous splenic rupture was made following clinical and radiological examination. She underwent emergency splenectomy and made a full, uneventful recovery. Histopathological examination confirmed splenic peliosis.The second case describes an eighty six year old lady who sustained a trivial fall and developed pain in her left side. A CT confirmed splenic rupture. She became haemodynamically unstable during her admission and underwent emergency splenectomy. Histopathological examination revealed splenic peliosis. She went on to make an uneventful recovery.Splenic peliosis is very rare. It has a number of associations including immunosuppression, drug therapy and infection. Although patients are often asymptomatic, life-threatening spontaneous organ rupture may occur. If the diagnosis of peliosis is confirmed, additional investigations should be considered to detect its presence in other organs. Furthermore, the presence of the condition may be relevant if further medical or surgical intervention is planned.Peliosis was first described in the liver (peliosis hepatis) by Schoenland in 1916 [1]. Most cases of splenic peliosis are associated with peliosis hepatis. Isolated splenic peliosis (peliosis lienis) is extremely rare. Its presence has only been reported thirty four times in the literature with only seven documented cases of organ rupture.Establishing its incidence has proved difficult since the condition either remains asymptomatic or is discovered incidentally at autopsy [14]. Tada et al. examined the spleens of 1,200 random autopsy cases [2] over a three year period. The presence of peliosis was noted in ten patients and in eight of these cases it was confined to the spleen alone.We present two patients with spontaneous splenic rupture and review the literature with regard to the surgical, pathological and radiological findings in