Rotura esplénica espontánea secundaria a un hemangioma en paciente femenina. A propósito de un caso: Spontaneous splenic ruptura

Abstract

Spontaneous splenic rupture secondary to splenic hemangioma is a rare but potentially serious condition. Clinically, a spontaneous splenic rupture should be suspected in a patient with abdominal pain in the epigastrium and/or left hypochondrium, radiating to the scapula and left shoulder (Kehr's sign), which evolves into a picture of peritoneal irritation and hypovolemic shock. The followig case is a white, 47-year-old female patient with a history of an ectopic pregnancy. The symptoms began suddenly with pain in the left hypochondrium that radiated to the interscapular region and shoulder on the same side, which, after 4 hours, moved to the ipsilateral iliac fossa, being associated with marked asthenia, dysuria, rectal tenesmus and shaking chills. He denies having received any trauma. On physical examination, hypocolored mucous membranes were found, blood pressure of 100/70 mm/Hg, slightly tachycardic, with a painful abdomen on palpation throughout the left hemiabdomen with predominance in the iliac fossa on the same side, with peritoneal reaction, decreased air fluid sounds, Painful vaginal examination upon mobilization of the cervix and bulging pouch of Douglas, painful rectal examination upon palpation of its anterior surface. After carrying out several tests, it is suspected that it is a hemorrhagic follicle, so it is announced in this way to the room. During the intervention, the initial diagnosis is ruled out, and a spontaneous splenic rupture is confirmed. Spontaneous splenic rupture constitutes a surgical emergency that is difficult to diagnose clinically since its symptoms are suggestive of different pathologies. The diagnosis of this pathology is essentially based on imaging studies, although there are cases like the one illustrated in which these do not imply an accurate diagnosis.