From the Guidelines
The incidence of spontaneous ruptured splenic infarct is extremely rare, and the exact incidence is not well-established in the provided evidence. Splenic infarction itself is uncommon, and most cases resolve without rupture. When rupture does occur, it typically happens in patients with underlying conditions that predispose to splenic infarction, such as hematologic malignancies, sickle cell disease, endocarditis, or hypercoagulable states. The risk of rupture increases with larger infarcts, especially those involving more than 50% of the splenic parenchyma. Patients with splenomegaly are at higher risk for both infarction and subsequent rupture.
Clinical Presentation and Diagnosis
Clinical presentation typically includes sudden onset of left upper quadrant pain, often with radiation to the left shoulder (Kehr's sign), hypotension, and peritoneal signs if hemoperitoneum develops. Diagnosis is confirmed by CT scan with intravenous contrast, which can identify both the infarct and evidence of rupture, as noted in studies such as 1.
Management
Management depends on hemodynamic stability, with unstable patients requiring emergency splenectomy, while stable patients with contained ruptures may be managed conservatively with close monitoring, pain control, and serial hemoglobin measurements. The approach to management is guided by principles outlined in trauma guidelines, such as those discussed in 1, 1, 1, 1, and 1, which emphasize the importance of patient stability and the role of operative management in certain cases.
Mortality Rate
The mortality rate for ruptured splenic infarcts is significant, ranging from 5-10%, primarily due to hemorrhagic shock if diagnosis and treatment are delayed. This highlights the importance of prompt recognition and appropriate management of splenic infarction and its complications.
Given the rarity of spontaneous ruptured splenic infarct and the variability in patient presentation and underlying conditions, a tailored approach to diagnosis and management is necessary, prioritizing hemodynamic stability and timely intervention when needed.
From the Research
Incidence of Spontaneous Ruptured Splenic Infarct
- The incidence of spontaneous ruptured splenic infarct is rare, with few cases reported in the literature 2, 3.
- A study published in 2004 reported a case of a 76-year-old woman who presented with an acute surgical abdomen due to a ruptured spleen, which was found to have occurred through areas of infarction 2.
- Another study published in 1998 reviewed 59 cases of splenic infarction and found that complications of splenic infarction, including rupture, were a frequent indication for operation in patients with emboli 3.
- The clinical spectrum of splenic infarction is varied, and symptoms may include abdominal pain, fever, and chills, as well as constitutional symptoms 3.
- Diagnostic tests, such as CT scan, are important for diagnosing splenic infarction, and ultimate diagnosis depends on pathologic examination of the spleen 3.
Risk Factors and Management
- Risk factors for splenic artery aneurysm, which can lead to rupture, include underlying pathological conditions, such as hematologic disorders and thromboembolic disorders 4, 5.
- Management of spontaneous ruptured splenic infarct typically involves surgical intervention, such as splenectomy, and may also involve management of underlying conditions 4, 5, 2.
- Prompt diagnosis and management are crucial to achieve a favorable outcome, and a high index of suspicion is needed to make the diagnosis in the absence of known risk factors 5.