Case Presentation:
We present a 51years old with a clear medical background who presented
to the emergency room with a 2 days history of dull aching pain in the
left upper quadrant that radiates to the left shoulder) and abdominal
examination showed tenderness and rigidity in the upper quadrant. He
denied any history of trauma. The patient received anti-malaria
treatment 5 days ago after he was diagnosed with malaria infection. He
was tachycardic and hypotensive. The patient was resuscitated in the
emergency department with iv fluids, blood transfusion, and iv
antibiotics.
Computed Tomography (CT) scan of the abdomen and pelvis demonstrated a 4
cm subscapular splenic hematoma with free peritoneal fluid indicating
grade III splenic rupture [Fig.1]. No active bleeding or contrast
extravasation was visualized. The liver appearance was remarkably
normal. An attempt for conservative management was tired, but the
patient had not responded to supportive treatment and an exploratory
laparotomy and splenectomy were performed [Fig 2-3].
The patient had an uneventful postoperative recovery. Follow-up one
month later in the outpatient department showed a return to his baseline
function and he received prophylactic vaccination against pneumococcal,
Neisseria, and Hemophilus.
Fig 1: Computed Tomography (CT) scan of the abdomen and pelvis
Fig 2: operative Specimen Showing splenic rupture
Fig 3: Fig 2: operative Specimen Showing splenic rupture