MyMedR

Fulltext Non-traumatic splenic rupture - a rare first presentation of diffuse large B-cell lymphoma and a review of the literature

Kaniappan K, Lim CTS, Chin PW

BMC Cancer, 2018 Aug 02;18(1):779.

PMID: 30068299 DOI: 10.1186/s12885-018-4702-1

BACKGROUND: Cases of non-traumatic splenic rupture are rare and entails a potentially grave medical outcome. Hence, it is important to consider the differential diagnosis of a non-traumatic splenic rupture in patients with acute or insidious abdominal pain. The incidence of rupture in Diffuse B-cell non-Hodgkin Lymphoma is highly infrequent (Paulvannan and Pye, Int J Clin Pract 57:245-6, 2003; Gedik et el., World J Gastroenterol 14:6711-6716, 2008), despite reports of various non-traumatic splenic rupture in the literature (Orloff and Peksin, Int Abstr Surg 106:1-11, 1958; Paulvannan and Pye, Int J Clin Pract 57:245-6, 2003). In this article, we attempt to highlight the features of a rare cause of splenic rupture that might serve as a future reference point for the detection of similar cases during routine clinical practice.

CASE PRESENTATION: A 40-year-old man presented with 1 week history of left hypochondriac pain associated with abdominal distention. There was no history of preceding trauma or fever. Clinical examination revealed signs of tachycardia, pallor and splenomegaly. He had no evidence of peripheral stigmata of chronic liver disease. In addition, haematological investigation showed anemia with leucocytosis and raised levels of lactate dehydrogenase enzyme. However, peripheral blood film revealed no evidence of any blast or atypical cells. In view of these findings, imaging via ultrasound and computed tomography of the abdomen was performed. The results of these imaging tests showed splenic collections that was suggestive of splenic rupture and hematoma. Patient underwent emergency splenectomy and the histopathological report confirmed the diagnosis as DLBCL.

CONCLUSIONS: The occurrence of true spontaneous splenic rupture is uncommon. In a recent systematic review of 613 cases of splenic rupture, only 84 cases were secondary to hematological malignancy. Acute leukemia and non-Hodgkin lymphoma were the most frequent causes of splenic rupture, followed by chronic and acute myelogeneous leukemias. At present, only a few cases of diffuse large B-cell lymphoma (DLBCL) have been reported. The morbidity and mortality rate is greatly increased when there is a delay in the diagnosis and intervention of splenic rupture cases. Hence, there should be an increased awareness amongst both physicians and surgeons that a non-traumatic splenic rupture could be the first clinical presentation of a DLBCL.

Matched MeSH terms: Splenic Rupture/etiology

Fulltext Spontaneous splenic rupture secondary to phaeyohyphomycosis and splenic abscesses

Sithasanan N, Chong LA, Ariffin H

Med J Malaysia, 2007 Aug;62(3):247-8.

PMID: 18246918 MyJurnal

Phaeohyphomycosis consists of a group of mycotic infections characterized by the presence of dematiaceous (dark walled) septate hyphae. Splenic abscess and spontaneous rupture is an infrequent complication in children with haematological malignancies and can be life threatening. To the best of our knowledge this is the first report of a case of splenic rupture following the development of multiple abscesses secondary to infestation by this rare fungal species.

Matched MeSH terms: Splenic Rupture/etiology

Fulltext Uterine perforation by the multiload CU250 intra-uterine device

Raman S, Sivanesaratnam V

Med J Malaysia, 1982 Mar;37(1):76-7.

PMID: 6889674

A case of perforation of the uterus by the Multiload CU250 Device is described. To date no perforation of the uterus by this device has been reported. The device was successfully removed under laparoscopic control.

Matched MeSH terms: Uterine Rupture/etiology*

A case of rupture of a main bronchus from a closed chest injury and its management in a child

Selvarajah N, Krishna SR

Med J Malaysia, 1974 Jun;28(4):276-8.

PMID: 4278977

Matched MeSH terms: Rupture/etiology*

Advanced abdominal pregnancy resulting from late uterine rupture

Naim NM, Ahmad S, Siraj HH, Ng P, Mahdy ZA, Razi ZR

Obstet Gynecol, 2008 Feb;111(2 Pt 2):502-4.

PMID: 18239000 DOI: 10.1097/01.AOG.0000279451.51446.c1

Advanced abdominal pregnancy is rare, and one that occurs after uterine rupture with delivery of a viable fetus is exceptional.

Matched MeSH terms: Uterine Rupture/etiology*

Case report of ruptured non-communicating right rudimentary horn pregnancy: an acute emergency

Hassan CH, Karim AK, Ismail NA, Omar MH

Acta Medica (Hradec Kralove), 2011;54(3):125-6.

PMID: 22250483

Ruptured pregnancy in the rudimentary horn of women who have had a vaginal delivery is rare and unpredictable. However, when undiagnosed, this condition could lead to maternal morbidity and mortality. We report a pregnancy at 19 weeks gestation presented with acute abdomen and hypovolemic shock. She was initially thought to have an intrauterine pregnancy with the provisional diagnosis of a ruptured uterus. Intraoperatively, a ruptured non-communicating right rudimentary horn with ex utero pregnancy was discovered.

Matched MeSH terms: Uterine Rupture/etiology

Fulltext Chronic rupture of the extensor apparatus of the knee joint

Poonnoose PM, Korula RJ, Oommen AT

Med J Malaysia, 2005 Oct;60(4):511-3.

PMID: 16570720

Chronic ruptures of the extensor mechanism of the knee are uncommon injuries, and previously reported literature assumes the presence of an intact patella for repair. We present a case of chronic rupture following patellectomy done twelve years previously. The defect in the extensor apparatus was extensive (18cm), and this was bridged using a large fascia lata graft from the opposite thigh, with reasonably successful results.

Matched MeSH terms: Rupture/etiology*

Rupture of the pregnant uterus--a 21-year review

Rachagan SP, Raman S, Balasundram G, Balakrishnan S

Aust N Z J Obstet Gynaecol, 1991 Feb;31(1):37-40.

PMID: 1872771

Uterine rupture is still a common problem in developing countries although even here the incidence varies from urban to rural settings. This article is a review of uterine rupture in an urban referral hospital in Malaysia. It examines aetiology, clinical presentation, complications and management of the problem. Meticulous screening of patients together with optimal antenatal and intrapartum care will markedly reduce the incidence of uterine rupture. Early diagnosis and prompt treatment will further help reduce morbidity and mortality to both mother and fetus.

Matched MeSH terms: Uterine Rupture/etiology*

Fulltext Uterine perforation by the intra-uterine device

Raman S, Sivanesaratnam V, Sinnathuray TA

Med J Malaysia, 1981 Sep;36(3):151-4.

PMID: 7199110

Matched MeSH terms: Uterine Rupture/etiology*

Rupture of the uterus: treatment by suturing the tear

Thambu JA

Med J Malaya, 1971 Jun;25(4):293-4.

PMID: 4261304

Matched MeSH terms: Uterine Rupture/etiology

Fulltext Spontaneous Rupture in a Non-Laboring Uterus at 20 Weeks: A Case Report

Omar NS, Mat Jin N, Mohd Zahid AZ, Abdullah B

Am J Case Rep, 2020 Aug 10;21:e924894.

PMID: 32776917 DOI: 10.12659/AJCR.924894

BACKGROUND Uterine rupture is uncommon but when it happens, it can cause significant morbidity and mortality to both mother and fetus. Incidence reportedly is higher in scarred than in unscarred uteri. Most cases occur in laboring women in their third trimester with a previous history of uterine surgery, such as caesarean delivery or myomectomy. We present a case of spontaneous uterine rupture in a non-laboring uterus in the mid-trimester of pregnancy. CASE REPORT The patient presented with threatened miscarriage at 17 weeks' gestation and ultrasound findings were that raised suspicion of a morbidly adherent placenta. Her history was significant for two previous cesarean deliveries more than 5 years ago followed by two spontaneous complete miscarriages in the first trimester. The patient was managed conservatively until 20 weeks' gestation, when she presented with acute abdomen with hypotensive shock. Her hemoglobin dropped to a level such that she required blood transfusion. An emergency exploratory laparotomy was performed, which revealed a 5-cm rupture in the lower part of the anterior wall of the uterus, out of which there was extrusion of part of the placenta. Given the patient's massive bleeding, the decision was made to proceed with subtotal hysterectomy. Histopathology of the specimen confirmed the diagnosis of placenta percreta. CONCLUSIONS Identification of uterine scarring with morbidly adherent placenta is crucial because even in early pregnancy, it can lead to uterine rupture. Furthermore, failure to recognize and promptly manage uterine rupture may prove fatal.

Matched MeSH terms: Uterine Rupture/etiology*

Perforation of the spinal cord by a herniated thoracic intervertebral disc. Report of a case

Arumugasamy N

Med J Malaya, 1969 Jun;23(4):250-2.

PMID: 4242169

Matched MeSH terms: Rupture/etiology

"Once a Caesarean section"

Kuah KB

Med J Malaya, 1970 Sep;25(1):38-42.

PMID: 4249492

Matched MeSH terms: Uterine Rupture/etiology

Myocardial Rupture Secondary to Ventricular Septal Hematoma: A Case Report and Review of Contemporary Literature

Haranal M, Hew CC, Dillon JJ

World J Pediatr Congenit Heart Surg, 2019 11;10(6):793-795.

PMID: 31701824 DOI: 10.1177/2150135119872202

Interventricular septal hematoma following congenital cardiac surgery is an uncommon entity. Literature search reveals few cases of interventricular septal hematoma complicating pediatric cardiac surgery. We report a case of interventricular septal hematoma following patch closure of ventricular septal defect, with associated myocardial necrosis and myocardial rupture.

Matched MeSH terms: Heart Rupture/etiology*

A rare complication of endoscopic cystgastrostomy

Lee J, Sachithanandan S, Raman K

Gastroenterology, 2011 Nov;141(5):e1-2.

PMID: 21946349 DOI: 10.1053/j.gastro.2010.07.062

Matched MeSH terms: Splenic Rupture/etiology*

Fulltext Abdominal aortic aneurysm--a plea for early elective excision (aneurysmectomy)

Leong YP

Med J Malaysia, 1991 Mar;46(1):51-8.

PMID: 1836038

Though peripheral arterial disease is not as common as in the Western countries, abdominal aorit aneurysm (AAA) is the most frequent arterial problem in Malaysia. A prospective study was made of 100 consecutive patients who presented with AAA to the author between January 1986 to September 1988 (31 months' period). There were 88 males and 12 females. The age range was 47-90 years, mean = 68.7. All the major ethnic rates were equally affected. The sizes of the AAA were documented by ultrasonography and the diameters ranged from 3-10 centimetres, mean = 5.8. Aneurysmectomy was performed on 58 patients, 17 of which were emergencies for ruptured AAA. The operative mortality for elective surgery was 2 percent, but that for emergency surgery was 47 percent. Ten patients refused surgery and 28 were not offered an operation. The true incidence of AAA is likely to be much higher than the number of patients referred for treatment. Many cases are not diagnosed or referred for treatment. Many cases of ruptured AAA died at home or in peripheral hospitals without a diagnosis being made. It is estimated that an AAA is present in 17,000 persons in Peninsular Malaysia. The risk of elective surgery is significantly lower than that of emergency. The overall mortality for ruptured AAA is even higher at about 99 percent. Furthermore, AAA is a benign disease and after surgery the patients return to their normal life expectancy. It is recommended that patients with AAA of five centimetres or more should be advised surgery if premature death is to be avoided.

Matched MeSH terms: Aortic Rupture/etiology

Fulltext Splenic amyloidosis: a rare cause of spontaneous splenic rupture

Chan RS, Abdul Aziz YF, Chandran P, Ng EK

Singapore Med J, 2011 Nov;52(11):e232-5.

PMID: 22173263

A 62 year-old woman who presented with an atraumatic acute abdomen was discovered to have haemoperitoneum with splenic rupture on urgent computed tomography and was immediately referred for life-saving emergency splenectomy. Histopathological examination revealed secondary splenic amyloidosis. The patient was later found to be suffering from infective endocarditis secondary to her permanent cardiac pacemaker. This report describes a patient who could have suffered from a long-standing infected vegetation on a permanent cardiac pacemaker, which led to splenic amyloidosis and spontaneous splenic rupture.

Matched MeSH terms: Splenic Rupture/etiology

Definitive surgery for perforated peptic ulcer in Malaysia

Ti TK, Yong NK

Aust N Z J Surg, 1973 May;42(4):353-6.

PMID: 4532515

Matched MeSH terms: Stomach Rupture/etiology

Maternal and neonatal effects of Acinetobacter colonisation in preterm premature rupture of membrane and term labour

Sood M, Mohd Zain Z, Abu NA, Chee SC, Mohd Nor NS

Med J Malaysia, 2019 02;74(1):40-44.

PMID: 30846661

INTRODUCTION: Some anecdotal reports suggest that maternal colonisation with Acinetobacter baumannii during pregnancy is associated with adverse maternal and neonatal effects, including preterm premature rupture of membrane (PPROM). The objective of this study was to compare the maternal and neonatal effects of A. baumannii colonisation in cases with PPROM and those with spontaneous onset of labour at term.

METHODS: The recruitment of participants' was carried out at Selayang Hospital, Selangor, Malaysia. Vaginal swabs were prospectively taken from 104 patients of PPROM and 111 with spontaneous onset of labour at term. Swabs were also taken from the axillae and ears of their babies. These swabs were cultured to isolate A. baumannii. Maternal and neonatal adverse outcomes were documented.

RESULTS: Sixteen mothers were A. baumannii positive, eight from each group respectively. None of the cases developed chorioamnionitis or sepsis. Those positive were four cases of PPROM and two babies of term labour. None of the babies developed sepsis.

CONCLUSIONS: This study does not support the suggestion that A. baumannii colonisation during pregnancy is associated with adverse maternal and neonatal outcomes.

Matched MeSH terms: Fetal Membranes, Premature Rupture/etiology

Uterine-conserving approach in ruptured intramyometrial ectopic pregnancy

Esther LSY, Chew KT, Rahman RA, Zainuddin AA, Hing EY, Kampan N

Horm Mol Biol Clin Investig, 2020 Mar 13;41(2).

PMID: 32167930 DOI: 10.1515/hmbci-2020-0001

Intramyometrial ectopic pregnancy (IMEP) is a rare form of ectopic pregnancy. It is defined as a conceptus implanted within the myometrium and is completely surrounded by myometrium with clear separation from both the uterine cavity and tubes. IMEP possesses not only diagnostic but also therapeutic challenge. The majority of reported cases were managed by hysterectomy. Early management of unruptured IMEP using methotrexate may help to preserve fertility. We, for the first time, report a case of ruptured IMEP managed successfully using suction and curettage followed by Bakri balloon tamponade and avoiding hysterectomy. Post-procedure, the patient received two doses of intramuscular methotrexate 50 mg/m2 due to plateauing serial beta human chorionic gonadotropin (β-hCG) levels and subsequently achieved undetectable level 10 weeks post-methotrexate. She also had complete resolution of the ectopic intramyometrial mass.

Matched MeSH terms: Uterine Rupture/etiology

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