Spontaneous Rupture of a True Splenic Cyst Diagnosed by Laparoscopy

Excerpt

Splenic rupture is described in the literature following trauma and has an approximately 30% occurrence following blunt abdominal injury [1]. On the other hand, nontraumatic or spontaneous rupture of the spleen is uncommon and when it occurs usually involves some type of underlying pathology [2, 3]. Conditions reported to be associated with nontraumatic splenic rupture include infectious (infectious mononucleosis, viral hepatitis, malaria), malignant (lymphoma, leukemia) hematological (hemophilia, hemolytic anemia), and miscellaneous (sarcoidosis, amyloidosis, splenic vein thrombosis, splenic infarction, splenic aneurysm, and splenic cysts) [4‐10]. Diagnosing spontaneous rupture of a splenic cyst is not easy because there is a wide variety of signs and symptoms which tend to blur the diagnostic picture [1]. The presenting symptoms may mimic a variety of pathologic conditions, including myocardial infarct, pulmonary embolism, acute appendicitis, diverticulitis, and ectopic pregnancy [11‐13]. Sometimes spontaneous rupture of a splenic cyst is not considered in the differential diagnosis of acute abdominal pain and this can have devastating consequences. In the majority of cases, the clinical findings and the noninvasive imaging modalities (plain abdominal x-rays, U/S, and CT scan) provide enough information to assist the clinician in ascertaining a correct diagnosis. However, at times, the clinical presentation is confusing and discrepancies may exist between a vague clinical picture and the imaging results. Diagnostic laparoscopy in such cases may be very helpful in clarifying the problem thereby leading to a prompt diagnosis. We present a 35-year-old female who had an unclear clinical picture, and although she underwent an assortment of noninvasive imaging modalities including U/S and CT scan, diagnostic laparoscopy was necessary to provide the definitive diagnosis. We present this as a case of a spontaneous rupture of a true splenic cyst, which is a rare clinical entity, as well as stressing the importance of laparoscopy as a diagnostic tool. …