Spontaneous Splenic Rupture in an Active Duty Marine
Spontaneous Splenic Rupture in an Active Duty Marine
Introduction: Atraumatic splenic rupture is a rare event that has been associated with several infectious disease processes. In the active duty military population, potential exposure to these pathogens is significant. Here we discuss the case of an active duty Marine with spontaneous splenic rupture upon return from a six-month deployment in Iraq.
Case presentation: A previously healthy 30-year-old Caucasian male active duty Marine presented with abdominal pain, fever and diarrhea after deployment to Iraq in support of Operation Iraqi Freedom. Based on clinical and radiographic evidence, a diagnosis of spontaneous splenic rupture was ultimately suspected. After exploratory laparotomy with confirmation of rupture, splenectomy was performed, and the patient made a full, uneventful recovery. Histopathologic examination revealed mild splenomegaly with a ruptured capsule of undetermined cause.
Conclusion: Spontaneous splenic rupture is a rare event that may lead to life-threatening hemorrhage if not diagnosed and treated quickly. Although the cause of this patient's case was unknown, atraumatic splenic rupture has been associated with a variety of infectious diseases and demonstrates some risks the active duty military population may face while on deployment. Having an awareness of these pathogens and their role in splenic rupture, clinicians caring for military personnel must be prepared to recognize and treat this potentially fatal complication.
Traumatic splenic rupture has been well documented, with an estimated 30% rate of occurrence after operatively managed blunt abdominal trauma. Spontaneous rupture of the spleen, however, is a rare clinical entity, and in the absence of trauma, the diagnosis and treatment of this potentially fatal complication are often delayed. Spontaneous splenic rupture has been described in the setting of known pathology, most commonly infectious and neoplastic processes affecting the reticuloendothelial system. Atraumatic rupture of the normal spleen has also been reported, although its legitimacy has long been debated. Regardless of the mechanism, patients typically present with upper abdominal pain, classically referred to the left shoulder (Kehr's sign), with evidence of peritonitis and hemodynamic instability. Here we present the case of a previously healthy 30-year-old Marine with atraumatic splenic rupture upon return from Iraq. Although no definitive cause was identified, the patient's clinical presentation suggested an infectious source. A variety of infectious pathogens are known to cause splenic enlargement and thus predispose to rupture. Several of these bacterial, viral and parasitic agents are endemic to the Middle East and nearby areas of military operations, placing deployed personnel in these regions at risk for exposure.
Abstract and Introduction
Abstract
Introduction: Atraumatic splenic rupture is a rare event that has been associated with several infectious disease processes. In the active duty military population, potential exposure to these pathogens is significant. Here we discuss the case of an active duty Marine with spontaneous splenic rupture upon return from a six-month deployment in Iraq.
Case presentation: A previously healthy 30-year-old Caucasian male active duty Marine presented with abdominal pain, fever and diarrhea after deployment to Iraq in support of Operation Iraqi Freedom. Based on clinical and radiographic evidence, a diagnosis of spontaneous splenic rupture was ultimately suspected. After exploratory laparotomy with confirmation of rupture, splenectomy was performed, and the patient made a full, uneventful recovery. Histopathologic examination revealed mild splenomegaly with a ruptured capsule of undetermined cause.
Conclusion: Spontaneous splenic rupture is a rare event that may lead to life-threatening hemorrhage if not diagnosed and treated quickly. Although the cause of this patient's case was unknown, atraumatic splenic rupture has been associated with a variety of infectious diseases and demonstrates some risks the active duty military population may face while on deployment. Having an awareness of these pathogens and their role in splenic rupture, clinicians caring for military personnel must be prepared to recognize and treat this potentially fatal complication.
Introduction
Traumatic splenic rupture has been well documented, with an estimated 30% rate of occurrence after operatively managed blunt abdominal trauma. Spontaneous rupture of the spleen, however, is a rare clinical entity, and in the absence of trauma, the diagnosis and treatment of this potentially fatal complication are often delayed. Spontaneous splenic rupture has been described in the setting of known pathology, most commonly infectious and neoplastic processes affecting the reticuloendothelial system. Atraumatic rupture of the normal spleen has also been reported, although its legitimacy has long been debated. Regardless of the mechanism, patients typically present with upper abdominal pain, classically referred to the left shoulder (Kehr's sign), with evidence of peritonitis and hemodynamic instability. Here we present the case of a previously healthy 30-year-old Marine with atraumatic splenic rupture upon return from Iraq. Although no definitive cause was identified, the patient's clinical presentation suggested an infectious source. A variety of infectious pathogens are known to cause splenic enlargement and thus predispose to rupture. Several of these bacterial, viral and parasitic agents are endemic to the Middle East and nearby areas of military operations, placing deployed personnel in these regions at risk for exposure.