title: [Splenic rupture secondary to abscess: Rare cause of pneumoperitoneum. Case report].
abstract: BACKGROUND
  Splenic abscesses are rare entities; reports are commonly described in immunocompromised patients (72%) as: hematologic diseases, diabetes, endocarditis, acquired immunodeficiency syndrome, transplant patients and subjects who had abdominal trauma or splenic infarction. The main and most serious complication is the abscess rupture into the peritoneal cavity or adjacent organs (stomach or colon), which determines hemodynamic instability or septic state.
  
  
  METHODS
  Fifty-year-old man, who was admitted at Emergency Room due eight days' progressive, oppressive, and current pain; intensity 4/10, irradiated at hemi-back, which was higher intensity during the standing and decreased at supine position. It was accompanied by nausea and vomiting in two occasions.
  Hemoglobin 15.1g/dl, hematocrit 45.2%, platelets 176×103, 23.1×103leukocytosis, neutrophils 92%. Simple abdominal radiographic studies revealed in 'ground glass' and radiopaque imagines.
  
  
  CONCLUSIONS
  At presence of free air inside the abdominal cavity, is usually to think of a complicated diverticular disease, intestinal perforation or perforated peptic ulcer. The actual medical literature described very few cases of splenic abscess with pneumoperitoneum as cardinal manifestation. In our case, the splenic abscess was detected during exploratory laparotomy and only in retrospective the imaging studies were interpreted.
authors.affiliation: Hospital Regional «Licenciado Adolfo López Mateos», Instituto de Servicios y Seguridad Social de los Trabajadores del Estado, Ciudad de México, México.
authors.forename: Jorge Enrique
authors.initials: JE
authors.lastname: Barrón-Reyes
authors.affiliation: Hospital Regional «Licenciado Adolfo López Mateos», Instituto de Servicios y Seguridad Social de los Trabajadores del Estado, Ciudad de México, México.
authors.forename: Julio César
authors.initials: JC
authors.lastname: Chávez-Galván
authors.affiliation: Hospital Regional «Licenciado Adolfo López Mateos», Instituto de Servicios y Seguridad Social de los Trabajadores del Estado, Ciudad de México, México.
authors.forename: Jesús Alejandro
authors.initials: JA
authors.lastname: Martínez-Peralta
authors.affiliation: Dirección General, Instituto de Servicios y Seguridad Social de los Trabajadores del Estado, Ciudad de México, México; Facultad de Medicina de Tampico «Dr. Alberto Romo Caballero», Universidad Autónoma de Tamaulipas, Tampico, Tamaulipas, México. Electronic address: jc.lopz@live.com.
authors.forename: Julio César
authors.initials: JC
authors.lastname: López-Valdés
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology; D000038:Abscess / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D003937:Diagnosis, Differential; D004240:Diverticulum / Q000175:diagnosis; D004630:Emergencies; D006465:Hemoperitoneum / Q000209:etiology; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000175:diagnosis; D011027:Pneumoperitoneum / Q000000981:diagnostic imaging / Q000209:etiology*; D012422:Rupture, Spontaneous; D013158:Splenic Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D013161:Splenic Rupture / Q000000981:diagnostic imaging / Q000209:etiology*
keywords: Absceso esplénico; Bazo; Haemoperitoneum; Hemoperitoneo; Neumoperitoneo; Pneumoperitoneum; Rotura esplénica; Spleen; Splenic abscess; Splenic rupture