SILENT EXPLOSION – CLINICAL CASE OF SPONTANEOUS RUPTURE IN A SPLEEN WITHOUT PATHOLOGY filipavcpinto@gmail.com

PE025

SILENT EXPLOSION – CLINICAL CASE OF SPONTANEOUS RUPTURE IN A SPLEEN WITHOUT PATHOLOGY

9

Hugo Capote Hugo.Capote@ulsaale.min-saude.pt Hospital Doutor José Maria Grande Portalegre Portugal

Portugal

Oral or Poster

Spontaneous splenic rupture (SSR) is a rare, potentially life threatening condition that poses significant diagnostic challenges. It is most commonly associated with infections, malignancies, or hematologic disorders, but may also occur in otherwise healthy spleens without identifiable underlying pathology. Prompt recognition is essential to optimize clinical outcomes.

We present a clinical case of spontaneous splenic rupture along with a review of the relevant literature.

A 62 year old female presented with the sudden onset of left upper quadrant pain in the absence of trauma. On examination, she was normotensive and tachycardic, with localized tenderness over the left hypochondrium and no signs of peritoneal irritation. Laboratory evaluation revealed hemoglobin of 8.5 g/dL, leukocyte count of 18,000/μL, and platelet count of 737,000/μL. Contrast enhanced computed tomography (CT) demonstrated splenic rupture with perisplenic hemoperitoneum extending into the paracolic gutters. The patient underwent exploratory laparotomy and splenectomy. The postoperative course was uneventful, and she was discharged seven days later after receiving prophylactic vaccinations. Histopathological analysis revealed splenic tissue with subcapsular and intraparenchymal hemorrhage, without additional abnormalities.

SSR in a morphologically normal spleen is exceedingly rare. Its pathophysiology remains uncompletely understood and may involve vascular fragility, microtrauma, increased intrasplenic pressure, and autolysis. Clinical presentation is often nonspecific. CT is the imaging modality of choice for diagnosis and grading of splenic injury. Management strategies range from conservative approaches to splenectomy, depending on the patient’s hemodynamic stability and the extent of splenic injury. Further research is warranted to elucidate the underlying mechanisms and identify predisposing factors.