title: An unusual diagnosis of splenic rupture.
abstract: A 22-year-old woman presented with a 3-day history of worsening epigastric pain, non-productive cough and vomiting. On examination she was pale and had abdominal tenderness predominant in the right upper quadrant. Abdominal ultrasound excluded the presence of gall stones, but was unable to rule out free fluid in the abdomen. CT demonstrated extensive high-density ascites; however, no source of bleeding could be demonstrated. Clinically the patient's condition deteriorated, and an exploratory laparotomy was performed. In theatre the splenic capsule was found to have detached from the splenic body and emergency splenectomy was performed. Virology serology later demonstrated acute cytomegalovirus (CMV) infection, although tissue microscopy and CMV staining were negative. No other cause of rupture was found. The interesting aspects of this case include the poor correlation between initial presenting symptoms and subsequent diagnosis, the difficulty encountered in making a firm diagnosis and the atypical cause of rupture.
authors.affiliation: Department of General Surgery, University College Hospital, London, UK.
authors.forename: Matthew
authors.initials: M
authors.lastname: Roche
authors.affiliation: Department of Accident and Emergency, University College Hospital, London, UK.
authors.forename: Fatmir
authors.initials: F
authors.lastname: Maloku
authors.affiliation: Department of General Surgery, University College Hospital, London, UK Department of General Surgery, Alexandria University, Alexandria, Egypt.
authors.forename: Tarek Ezzat
authors.initials: TE
authors.lastname: Abdel-Aziz
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D011859:Radiography; D012422:Rupture, Spontaneous; D013156:Splenectomy; D013161:Splenic Rupture / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D055815:Young Adult