Rupture of the spleen in the absence of trauma or previously diagnosed disease is largely ignored in the emergency literature and is often not documented as such in journals from other fields. We have conducted a systematic review of the literature to highlight the surprisingly frequent occurrence of this phenomenon and to document the diversity of diseases that can present in this fashion. Systematic review of English and French language publications catalogued in Pubmed, Embase and CINAHL between 1950 and 2011. We found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size) spleens in 35 cases and after minor trauma in 23 cases. Medications were implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its complications in 38 cases. The most common associated diseases were infectious (n = 143), haematologic (n = 84) and non-haematologic neoplasms (n = 48). Amyloidosis (n = 24), internal trauma such as cough or vomiting (n = 17) and rheumatologic diseases (n = 10) are less frequently reported. Colonoscopy (n = 87) was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n = 6), infarction (n = 6) and hamartomata (n = 5). Medications associated with rupture include anticoagulants (n = 21), thrombolytics (n = 13) and recombinant G-CSF (n = 10). Other causes or associations reported very infrequently include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm, cholesterol embolism, splenic granuloma, congenital diaphragmatic hernia, rib exostosis, pancreatitis, Gaucher's disease, Wilson's disease, pheochromocytoma, afibrinogenemia and ruptured ectopic pregnancy. Emergency physicians should be attuned to the fact that rupture of the spleen can occur in the absence of major trauma or previously diagnosed splenic disease. The occurrence of such a rupture is likely to be the manifesting complaint of an underlying disease. Furthermore, colonoscopy should be more widely documented as a cause of splenic rupture.

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613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review

Context.—Splenic rupture secondary to solid malignancy is an infrequent complication that usually occurs late in the progression of a previously diagnosed cancer. In rare instances, splenic rupture precipitates the discovery of an unsuspected pancreatic carcinoma. We report 2 cases of adenocarcinoma of the pancreas in which the patients presented with splenic rupture. Objectives.—To review the clinicopathologic features of splenic rupture due to pancreatic carcinoma and to increase awareness of malignancy as a possible etiology for atraumatic splenic rupture. Design.—We reviewed the clinical and pathologic data from 2 patients. A literature search was conducted to identify previous reports of splenic rupture associated with pancreatic cancer. We summarized the characteristics of the earlier cases and compared them with those of our patients. Results.—We found only 4 previous reports of splenic rupture preceding the diagnosis of pancreatic cancer. In 3 of these cases, the pancreatic carcinoma gros...

Splenic Rupture: A Rare Presentation of Pancreatic Carcinoma

We herein describe the case of a 59-year-old man who experienced a spontaneous splenic rupture 12 h after undergoing a left-side thoracotomy for a wedge resection of an unknown pulmonary nodular tumor following a history of malignant melanoma. He demonstrated no special abdominal diseases or traumas, except an uneventful cholecystectomy 12 years previously. Preoperatively, he was not on anticoagulation, aspirin, or nonsteroidal anti-inflammatory medication, and all coagulation tests were inconspicuous. At 12 h after lung surgery the patient showed signs of progredient hypovolemic shock. After ultrasonography, which showed a moderate amount of free intra-abdominal liquid, the patient was urgently taken to the operation room. Bleeding resulted from a rupture of an encapsulated hematoma from the spleen. No signs of adhesion around the spleen or of an injury of the left diaphragm were observed. A pathological analysis of the spleen revealed a normal dimension and a normal histological structure without any evidence of a hematological or neoplastic disease. The patient was discharged on the 12th day after surgery. A review on the literature and the differential diagnosis of this unusual case is presented and discussed.

Spontaneous splenic rupture after a left-side thoracotomy: report of a case.

Accessory spleen rupture in a patient with previous traumatic splenectomy

Rotura no traumática del bazo: experiencia con 10 casos

Background: Mucinous cystic neoplasms of the pancreas are uncommon tumors with varying potential for malignancy. Although traumatic splenic rupture is common, spontaneous rupture is

Unusual presentation of pancreatic mucinous cystadenocarcinoma by spontaneous splenic rupture.

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Unusual presentation of pancreatic mucinous cystadenocarcinoma by spontaneous splenic rupture.