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A case of spontaneous abdominal hemoperitoneum secondary to ruptured splenosis

Summary

This case report describes a rare complication where ectopic splenic tissue (splenosis) that had grown in the abdomen following a previous spleen removal suddenly ruptured and caused severe internal bleeding. The 35-year-old patient developed acute abdominal pain and underwent emergency surgery to remove the bleeding tissue and stop the hemorrhage. The surgery was successful and the patient recovered well, highlighting the importance of considering splenosis in the differential diagnosis of unexplained abdominal bleeding in patients with prior spleen removal.

Background

Spontaneous hemorrhage from splenosis is a rare phenomenon with limited clinical documentation. Splenosis occurs when splenic tissue fragments are seeded throughout the abdominal cavity following traumatic or iatrogenic splenic compromise. This case describes a 35-year-old patient with a history of splenectomy 23 years prior presenting with acute abdominal hemoperitoneum.

Objective

To present a case of spontaneous abdominal hemoperitoneum secondary to ruptured splenosis and describe successful surgical management. The study aims to contribute to the limited literature on this rare complication of splenosis.

Results

CT imaging revealed a large 17-cm amorphous hematoma in the left mesentery with active extravasation from a terminal splenic artery branch and two separate splenules. Exploratory laparotomy confirmed a 600 ml hematoma from a splenule with feeding vessels that were ligated. Pathology confirmed benign splenic tissue with hemorrhage.

Conclusion

Spontaneous hemorrhage from splenosis is rare but should be considered in the differential diagnosis of acute intraabdominal bleeding, especially in patients with prior splenectomy. Surgical intervention was successful in this case, though transarterial embolization and conservative management are alternative treatment options depending on clinical presentation.
  • Published in:Journal of Surgical Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 38721255, DOI: 10.1093/jscr/rjae284
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