Atraumatic splenic rupture

Case contributed by Dr Henry Knipe

Presentation

Peritoneal dialysis patient with bloody dialysate fluid.

Patient Data

Age: 50 year
Gender: Male
CT

Large splenic subcapsular haematoma with linear superior pole hypodensities. Haematoma extends into the left subphrenic space. Peripheral splenic hyperdensities (shown to be calcification when compared to previous imaging).

Extensive peritoneal free fluid in keeping with peritoneal haemodialysis - this is low density (10-15 HU) with layering or haematocrit effect identified. PD tubing noted.

5.5 cm infrarenal abdominal aneurysm with bi-iliac EVAR stent graft. Atrophic native kidneys with multiple cysts, and atrophic right iliac fossa transplant kidney noted. Irregular liver surface. Adrenal glands, pancreas, gallbladder and bowel is unremarkable. 

Case Discussion

This patient had been treated with peritoneal dialysis for a number of years. There was no history of recent or remote trauma, and the patient was essentially asymptomatic aside from bloody peritoneal dialysate and mild abdominal pain. 

Atraumatic splenic rupture has been reported as a rare occurrence in both haemodialysis and peritoneal dialysis patients. In a series of 22 dialysis patients who had splenectomy for atraumatic rupture 1, amyloidosis was the most common underlying pathology (~30%), with other underlying pathology including splenomegaly, haemosiderosis, splenic infarcts, and tuberculous granulomas. 

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Case information

rID: 42931
Case created: 15th Feb 2016
Last edited: 23rd May 2017
Inclusion in quiz mode: Included

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