Spontaneous Splenic Rupture – A Complication Of Cirrhosis With Portal Hypertension

Abstract

 Introduction: Splenic rupture is a potentially life-threatening condition, often associated with trauma. Spontaneous rupture is very rare and is usually reported as being secondary to underlying pathological conditions.

Case Report: An 89-year-old female patient presented to the emergency department with a sudden-onset abdominal pain in the left hypochondrium following a coughing episode. Investigation revealed that the patient had a spleen with signs of laceration with evidence of acute hemorrhage. The patient’s condition deteriorated clinically with hemodynamic instability and an exploratory laparotomy was proposed. During laparotomy a splenic rupture was identified and the decision was made to proceed to a splenectomy.
Discussion: Non-traumatic splenic rupture, is a rare but life-threatening complication. Clinical manifestations consist of sudden-onset left upper quadrant pain, abdominal rigidity and hemodynamic instability. Chronic liver cirrhosis is associated with multiple complications and portal hypertension causes increased congestion in the portal system, leading to splenomegaly. Even a minor physical event, such as coughing, vomiting, or sneezing might cause rupture of a pathologically fragile, enlarged spleen. Total splenectomy is the mainstay of treatment and allows diagnosis of the underlying problem.