03 June 2022 : Case report
[In Press] Acute Abdomen from Spontaneous Splenic Artery Rupture with Coincidental Metastatic Disease: A Case Report
Challenging differential diagnosis, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)Dharti Patel1ABCDEF
Am J Case Rep In Press; DOI: 10.12659/AJCR.936987
Available online: 2022-06-03, In Press, Corrected Proof
Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule
Splenic artery rupture is a rare surgical occurrence, often with fatal results. The reported prevalence is 0.1-0.2%. Splenic artery rupture can be from atraumatic or traumatic causes. Clinical presentation can vary from being asymptomatic to having an acute abdomen presentation if the splenic artery ruptures. Various imaging studies such as computed tomography, magnetic resonance imaging, and Doppler ultrasound can be used to determine the morphology and location of the aneurysm. Surgical treatment options are aneurysm resection or simple ligation and splenectomy.
We present the case of an 84-year-old man who presented to the Emergency Department after having an episode of syncope. Upon admission, the patient had an acute rupture of the splenic artery aneurysm with large-volume hemoperitoneum, with extensive hepatic and periportal nodal metastases. Interventional radiology was immediately consulted for an emergent splenic artery embolization. He then underwent a liver biopsy, showing poorly differentiated carcinoma, with elevated AFP, CA 19-9, and CEA. The patient was discharged, and was scheduled to follow up with gastroenterology for an outpatient colonoscopy and with oncology for further staging and treatment.
This is a rare case where a patient had an acute splenic artery rupture with underlying hepatic and periportal metastasis, with a primary within the gastroenterology tract, specifically the colon. It is imperative to consider splenic artery aneurysm as a differential diagnosis in patients who present with acute abdomen. This case will bring to light a traumatic cause leading to a delayed diagnosis of metastatic malignancy, with the colon as the primary location.
Keywords: Aneurysm, Ruptured; Colonic Neoplasms; Splenic Artery
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