Atraumatic splenic rupture as first manifestation of different underestimated clinical conditions

BACKGROUND: Atraumatic spleen rupture (ASR) is a rare, life-threatening clinical condition, which can be categorized as idiopathic or secondary to a variety of causes (i.e. malignancies), infectious/inflammatory diseases, drugs or invasive medical treatments and mechanical disorders. So far, no guidelines exist as to how manage patients with ASR. Furthermore, the identification of ASR in the Emergency Department may be challenging, leading to misdiagnosis and delayed treatment. METHODS: The present study aimed to perform a retrospective analysis of the whole series of cases with ASR identified at the Emergency Department of the St. Anna University Hospital, Cona, Ferrara, Italy, from 2009 to 2020, with particular interest for the last two occurred in 2020. Furthermore, a literature review about ASR has been performed. RESULTS: Among the 17 patients with ASR detected, the majority (N.=6) were related to malignancies, whereas others were associated to anticoagulant treatment (N.=4), infectious diseases (N.=1), mechanical/inflammatory disorders (N.=5) and peritoneal dialysis (N.=1). Most of these patients underwent urgent splenectomy, while the conservative treatment (e.g., vascular embolization) was performed only few times in one patient. Five patients died during the hospital stay. The literature review highlighted that mechanical disorders were the main cause of ASR, in contrast to our data showing a predominant component of malignancies. Splenectomy is the most common treatment compared to nonoperative management and vascular embolization. CONCLUSIONS: Our study provided emergency physicians with an update on ASR, which may help to recognize and manage this potentially life-threatening clinical condition.