Case Report - Volume 2 - Issue 3
Spontaneous Rupture of the Spleen Due To Malaria A Case Report
Albra Hegazi1* ; Almuntasir Beallah Eltayb2; Yusra Elhassan3 ; Tagwa Hegazi4
1The resident of General Surgery at Sudan Medical Specialization Board, Khartoum, Sudan, Khartoum Teaching Hospital, Sudan.
2Chief resident of urology at Sudan Medical Specialization Board, Khartoum, Sudan, Khartoum Teaching Hospital, Sudan.
3Resident of Microbiology at Sudan Medical Specialization Board.
4Resident of Psychiatric at Sudan Medical Specialization Board.
5Cheif resident of General Surgery at Sudan Medical Specialization Board.
6Senior residents of General Surgery at Sudan Medical Specialization Board.
Received Date : Mar 30, 2022
Accepted Date : May 05, 2022
Published Date: May 19, 2022
Copyright:© Almuntasir Beallah Eltayb 2022
*Corresponding Author : Albra Hegazi, Chief resident of urology at Sudan Medical Specialization Board, Khartoum, Sudan, Khartoum Teaching Hospital, Sudan.
Email: albrahegazi@gmail.com
DOI: Doi.org/10.55920/2771-019X/1147
Abstract
Background: Malaria is of the commonest diseases in Sudan and a major cause of morbidity and mortality. Its transmitted by Anopheles mosquito bite. It has well described and common complications that most of the clinicians in Sudan are familiar with its presentation and how to deal with it. However, Malarial splenic rupture (MSR) is uncommon even in highly endemic areas Malaria and is a dramatic complication demanding prompt recognitions and surgical treatment.
Case presentation: We report on a 51-year-old male who was diagnosed with severe malaria infection and presented with an acute abdomen due to spontaneous splenic rupture.
Conclusion: This case emphasizes the importance of maintaining a high index of suspicion for this insidious condition in addition to closely monitoring such patients.
Background
Malaria is a mosquito borne illness that can infect human. Malaria infection ranges from febrile illness that can be easily treated to a life-threating condition that can be deadly. According to the WHO Malaria is endemic in Sudan and there is over 1.8 Million cases has been reported in 2019 [1]. Spleen is the main organ utilized by the body while fighting malaria infection by producing antibodies and to do that it undergoes structural changed characterized by enlargement, which is responsible for the development malarial splenic complications. Even in in endemic area MSR is a rare complication of Malaria [2].
Case Presentation
We present a 51 years old who presented to the emergency room with 5 days history of dull aching pain in the left upper quadrant that radiates to the left shoulder (Kehr’s sign) and abdominal examination showed tenderness and rigidity in the upper quadrant. He denied any history of trauma. Patient received anti malaria treatment 2 days ago after he diagnosed as malaria infection. Computed Tomography (CT) scan of the abdomen and pelvis demonstrated a 4 cm subscapular splenic hematoma with free peritoneal fluids indicating grade III splenic rupture [Figure 1]. No active bleeding or contrast extravasation was visualized. The liver appearance was remarkably normal. There was no ascites, and the splenic, mesenteric, and portal veins were patient. Exploratory laparotomy and splenectomy was performed [Figure 2-3]. The patient had an uneventful postoperative recovery.
Figure 1: Computed Tomography (CT) scan of the abdomen and pelvis.
Figure 2: Exploratory laparotomy.
Figure 3: Exploratory splenectomy.
Discussion
The exact mechanism responsible for the development of this complication is not known but these is three mechanism that were hypothesized:( 1) Cellular hyperplasia and venous-sinusoidal engorgement leading to congestion and increased tension and stress on the capsule, (2) vascular occlusion of the reticuloendothelial cells and hyperplasia resulting in thrombotic/ischemic phenomena, and (3) through the episodic increase in intra-abdominal pressure with coughing, sneezing, laughing which would put stress on the diseased and friable spleen. These factors combined causes a subscapular hematoma to from and a capsular tear which eventually causes rupture and free intrapertioneal hemorrhage. Spontaneous splenic rupture is more common in the acute infection because in chronic or recurrent malaria the splenic enlargement is less pronounced and healing by fibrosis from previous attacks makes it less frequent [3]. Splenic rupture has been reported with all malaria species infections but plasmodium vivax has been more associated with this complication because it produce more pronounced splenomegaly [4]. Clinical features Malaria splenic rupture are due abdominal symptoms caused by rupture (abdominal pain radiating to the left shoulder and peritonitis) and circulatory collapse from on-going bleeding and the main cause of the death in these patient is shock [5]. Abdominal ultrasound can be helpful in finding subscapular hematoma, perisplenic collection and free fluid (blood) in the peritoneal cavity [6]. However, the Abdominal CT scan is the gold standard for the confirmation of diagnosis with a sensitivity and specificity of 95% [7].Management of the case is dependent entirely upon the patient and to a lesser extent the availability of resources. Conservative management involve administration of antimalarial medication and observation in the hospital for 14 days with strict bed rest and giving fluid and blood as needed , a CT scan or ultrasound of the abdomen should be done within two to three weeks to assess the spleen. Splenectomy is indicated in patient who present with shock which does not respond to treatment. Embolization of the splenic artery can done but it requires will equipped facilities [8]. There is a growing evidence that favors the use of conservative management in managing MSR even in endemic area, but the lack of resources in these areas might
Conclusion
We reported a rare case of a 51 year old male presenting acutely with spontaneous rupture of spleen secondary to Malaria infection, subsequently requiring removal. This case emphasizes the importance of maintaining a high index of suspicion for this insidious condition in addition to closely monitoring such patients. This allows prompt recognition and management of this rare cause of the deteriorating surgical patient optimizing patient outcomes.
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