Splenic rupture secondary to haemorrhagic infarct in lymphom
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A 62-year-old man with stage IV follicular lymphoma presented with acute left-sided abdominal pain, acute-on-chronic anaemia and thrombocytopenia. An urgent contrast-enhanced CT scan of the abdomen demonstrated the presence of haemoperitoneum. Irregular linear-branching hypodensities distorting the splenic parenchyma present in both arterial and portovenous phases, with presence of ill-defined hypoenhancing regions. Splenomegaly was present.

Notably, there was absence of trauma. Overall features were compatible with non-traumatic rupture of the spleen. The patient underwent emergency laparotomy, revealing 3 L of blood clots in the peritoneal cavity. Slow oozing of blood was noted at the region of the splenic hilum.

Splenectomy was performed. Histopathological evaluation demonstrated features of diffuse large B-cell lymphoma with subcapsular infarct and haemorrhage. The surgery was uneventful. However, due to concurrent comorbidities and general ill-health, the patient progressively deteriorated and finally succumbed about a month after the surgery.

Learning points:-

• Non-traumatic splenic rupture should be considered in patients with splenomegaly, particularly those with pre-existing disease such as haematological malignancy.

• Prompt imaging is useful in confirming splenic rupture and can lead to early splenectomy, reducing morbidity and mortality in this potentially life-threatening disease entity

Source: https://casereports.bmj.com/content/12/1/e229052