Clinical medicine insights. Case reports · 2025
True Spontaneous Splenic Rupture Mimicking Peptic Ulcer Disease: A Case Report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Andargie Dereje G, Mengistie Biruk T, Mengistie Chernet T, Adigeh Zelalem L, Ami Bel
Аннотация
INTRODUCTION: Spontaneous splenic rupture (SSR) is an uncommon and potentially life-threatening cause of acute abdominal pain, often linked to underlying pathology. Because its presentation can mimic more common conditions, diagnosis is frequently delayed. We report a case from a resource-limited setting where SSR initially mimicked peptic ulcer disease, underscoring diagnostic challenges.
CASE PRESENTATION: A 57-year-old Ethiopian woman with chronic reflux presented after 5 days of severe epigastric pain radiating to the left shoulder, with nausea and vomiting but no trauma or fever. Initial labs showed mild anemia. Abdominal examination revealed localized epigastric tenderness without peritonism. The initial working diagnosis was peptic ulcer disease; proton pump inhibitors were started, and endoscopy was unavailable. After 2 days, she developed hypotension and left upper quadrant pain. Bedside ultrasound (FAST) showed free intraperitoneal fluid, and contrast CT confirmed a ruptured spleen with hemoperitoneum.
MANAGEMENT AND OUTCOME: The patient underwent emergency laparotomy, which found a shattered spleen and ~3.5 L of intra-abdominal blood; a splenectomy was performed. She required an intraoperative transfusion and was stabilized. Histopathology confirmed a normal spleen with preserved architecture, supporting a diagnosis of idiopathic rupture possibly related to transient microvascular congestion. Postoperatively, she recovered uneventfully and was discharged on postoperative day 5. She received the vaccinations needed and was counseled about infection risk.
CONCLUSION: This case illustrates that true spontaneous rupture can occur in a histologically normal spleen and may mimic peptic ulcer disease in presentation. Recognizing atypical features and ensuring timely imaging are crucial, especially in resource-limited settings where delayed diagnosis increases mortality.
CASE PRESENTATION: A 57-year-old Ethiopian woman with chronic reflux presented after 5 days of severe epigastric pain radiating to the left shoulder, with nausea and vomiting but no trauma or fever. Initial labs showed mild anemia. Abdominal examination revealed localized epigastric tenderness without peritonism. The initial working diagnosis was peptic ulcer disease; proton pump inhibitors were started, and endoscopy was unavailable. After 2 days, she developed hypotension and left upper quadrant pain. Bedside ultrasound (FAST) showed free intraperitoneal fluid, and contrast CT confirmed a ruptured spleen with hemoperitoneum.
MANAGEMENT AND OUTCOME: The patient underwent emergency laparotomy, which found a shattered spleen and ~3.5 L of intra-abdominal blood; a splenectomy was performed. She required an intraoperative transfusion and was stabilized. Histopathology confirmed a normal spleen with preserved architecture, supporting a diagnosis of idiopathic rupture possibly related to transient microvascular congestion. Postoperatively, she recovered uneventfully and was discharged on postoperative day 5. She received the vaccinations needed and was counseled about infection risk.
CONCLUSION: This case illustrates that true spontaneous rupture can occur in a histologically normal spleen and may mimic peptic ulcer disease in presentation. Recognizing atypical features and ensuring timely imaging are crucial, especially in resource-limited settings where delayed diagnosis increases mortality.