Spontaneous splenic rupture: an unusual presentation of CML

A 47-year-old man presented with sudden onset of severe, generalised abdominal pain and collapse. He also had a 4-month history of lethargy and weight loss. On examination he was shocked with a distended tender abdomen. He had haemoglobin of 3.8 g/dl and a white cell count count of 280.3×109/l with...

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Bibliographic Details
Published in:BMJ case reports 2011-03, Vol.2011 (mar16 1), p.bcr0220113879-bcr0220113879
Main Authors: Jafferbhoy, Sadaf, Chantry, Andrew, Atkey, Neil, Turner, Douglas, Wyld, Lynda
Format: Article
Language:English
Subjects:
Abdomen
Emergency medical care
Europe (West)
Hematology
Humans
Leukemia, Myelogenous, Chronic, BCR-ABL Positive - complications
Leukemia, Myelogenous, Chronic, BCR-ABL Positive - diagnosis
Male
Middle Aged
Rupture, Spontaneous - diagnosis
Rupture, Spontaneous - etiology
Spleen
Splenic Rupture - diagnosis
Splenic Rupture - etiology
Unusual Presentation of More Common Disease/Injury
Veins & arteries
White
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Summary:A 47-year-old man presented with sudden onset of severe, generalised abdominal pain and collapse. He also had a 4-month history of lethargy and weight loss. On examination he was shocked with a distended tender abdomen. He had haemoglobin of 3.8 g/dl and a white cell count count of 280.3×109/l with predominance of neutrophils. Arterial gases showed mixed metabolic-respiratory acidosis. A CT scan of abdomen showed active extravasation in splenic bed. In view of probable hyperviscosity syndrome, it was decided to attempt an angiographic embolisation. This was successfully carried out but 4 h later, he developed abdominal compartment syndrome and underwent a laparotomy and splenectomy. Subsequently, bone marrow aspirates were taken which showed granulocytic hyperplasia. Cytogenetic studies confirmed the presence of Philadelphia Chromosome and he was started on Imatinib. It is now 5 months since diagnosis and he has achieved complete haematological and cytogenetic response.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr.02.2011.3879