Splenic rupture

Case contributed by Dr Bruno Di Muzio

Presentation

Left flank pain with symptoms of left diaphragmatic irritation. No history of trauma. Referred massage one day ago.

Patient Data

Age: 61-year-old
Gender: Female
CT

CT Abdomen and pelvis

Large splenic subcapsular haematoma with contrast blush foci inferring active bleeding. Hypoenhancing areas of the splenic parenchyma are mostly superficial and with less than 3 cm in depth; splenic vascular hilum appears preserved. Free intraperitoneal fluid is of haematic content. The liver, pancreas, and adrenal glands are unremarkable. Bilateral renal cysts demonstrated, with no suspicious enhancement. No evidence of renal calculi. No abnormality of the bowel is identified. No free gas. No lymph node enlargement. No fractures or suspicious bone lesions.

DSA (angiography)

Splenic artery embolisation

Proximal splenic embolisation performed with 6, 5 and 4 mm Interlock detachable microcoils to stasis. 

Treatment images courtesy of the Royal Melbourne Hospital Interventional Radiology team. 

Case Discussion

This case illustrates a splenic rupture of unknown cause, presumed atraumatic. The patient has mentioned a history of massage one day ago but referred it was a more relaxing and not strong message. No evidence of splenomegaly or other underlying condition to explain the spontaneous rupture. 

The patient was considered with a borderline hemodynamic instability, and a splenic artery embolisation was proposed as the treatment. 

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Case information

rID: 48974
Case created: 3rd Nov 2016
Last edited: 5th Nov 2016
Tag: rmh
Inclusion in quiz mode: Included

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