Systematic review of atraumatic splenic rupture.
BACKGROUND
Atraumatic splenic rupture (ASR) is an ill defined clinicopathological entity.


METHODS
The aim was to characterize aetiological and risk factors for ASR-related mortality in order to aid disease classification and treatment. A systematic literature review (1980-2008) was undertaken and logistic regression analysis employed.


RESULTS
Some 632 publications reporting 845 patients were identified. The spleen was normal in 7.0 per cent (atraumatic-idiopathic rupture). One, two or three aetiological factors were found in 84.1, 8.2 and 0.7 per cent respectively (atraumatic-pathological rupture). Six major aetiological groups were defined: neoplastic (30.3 per cent), infectious (27.3 per cent), inflammatory, non-infectious (20.0 per cent), drug- and treatment-related (9.2 per cent) and mechanical (6.8 per cent) disorders, and normal spleen (6.4 per cent). Treatment comprised total splenectomy (84.1 per cent), organ-preserving surgery (1.2 per cent) or conservative measures (14.7 per cent). The ASR-related mortality rate was 12.2 per cent. Splenomegaly (P = 0.040), age above 40 years (P = 0.007) and neoplastic disorders (P = 0.008) were associated with increased ASR-related mortality on multivariable analysis.


CONCLUSIONS
The condition can be classified simply into atraumatic-idiopathic (7.0 per cent) and atraumatic-pathological (93.0 per cent) splenic rupture. Splenomegaly, advanced age and neoplastic disorders are associated with increased ASR-related mortality.
Department of Visceral Surgery and Medicine, Inselspital, Berne University Hospital, and University of Berne, Berne, Switzerland. pietro.renzulli@stgag.ch
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Renzulli
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Hostettler
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Schoepfer
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Gloor
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Candinas
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012422:Rupture, Spontaneous / Q000209:etiology / Q000401:mortality / Q000628:therapy; D013161:Splenic Rupture / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D013163:Splenomegaly / Q000150:complications / Q000401:mortality; D055815:Young Adult