Atraumatic splenic rupture in young adult following cocaine use

Joshua Lee Ramos; Michael Farr; Seung Hoon Shin; Nasim Ahmed

doi:10.1016/j.ijscr.2019.10.081

Atraumatic splenic rupture in young adult following cocaine use

Int J Surg Case Rep. 2019:65:168-170. doi: 10.1016/j.ijscr.2019.10.081. Epub 2019 Nov 3.

Authors

Joshua Lee Ramos¹, Michael Farr², Seung Hoon Shin¹, Nasim Ahmed³

Affiliations

¹ Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune, NJ, USA.
² Department of Surgery, Monmouth Medical Center, Long Branch, NJ, USA.
³ Division of Trauma & Surgical Critical Care, Jersey Shore University Medical Center, Neptune, NJ, USA. Electronic address: Nasim.Ahmed@hackensackmeridian.org.

Abstract

Introduction: Splenic rupture most commonly results from a traumatic mechanism. Spontaneous splenic ruptures are a rare occurrence. This is an interesting and rare case of atraumatic splenic rupture (ASR) presented after sniffing cocaine.

Presentation of case: The patient presented with abdominal pain and tenderness with low hemoglobin on admission. The computed tomography (CT) scan of the abdomen showed possible spleen rupture with hemoperitoneum. An emergent laparotomy and total splenectomy was performed. The pathology confirmed splenomegaly and a large area of adhesion. Adjacent to the adhesion, a focal disruption of splenic parenchyma was found.

Discussion: ASR has been reported in the literature due to infection, inflammation, mechanical and use of certain drugs. Few cases of ASR have been described due to cocaine use. Splenomegaly is one of the risk factors of ASR. The most probable mechanism of ASR in cocaine use is sudden vasoconstriction, ischemia and infarction of the parenchyma of the spleen, which can result in vascular rupture. Our case of ASR echoes the above process.

Conclusion: Total splenectomy resulted in a good outcome. The patient was discharged home without any services.

Keywords: Atraumatic splenic rupture; Cocaine; Splenomegaly.