Haemorrhagic Shock Following Spontaneous Rupture of a Cystic Lymphangioma of the Spleen - Case Report

Case Report

Austin J Anesthesia and Analgesia. 2020; 8(1): 1082.

Haemorrhagic Shock Following Spontaneous Rupture of a Cystic Lymphangioma of the Spleen - Case Report

Elbouti A*, Massad I, Touab R, Andaloussi MR, Chouikh C, Balkhi H

Department of Anesthesiology and Reanimation, Military Hospital Mohammed V. Rabat, Morocco

*Corresponding author: Elbouti Anass, Department of Anesthesiology and Reanimation, Military Hospital Mohammed V. Rabat, Morocco

Received: December 13, 2019; Accepted: January 13, 2020; Published: January 20, 2020

Abstract

Spontaneous rupture of the spleen is a rare, but potentially fatal phenomenon. The diagnosis is sometimes difficult, and often reveals an underlying pathology; however, the prognosis is highly related to early diagnosis and treatment. Cystic Lymphangioma (CL) is a benign tumor developed in the lymphatic vessels, although the splenic localization is exceptional. The isolated splenic lymphangiomas are asymptomatic and they are often incidentally discovered when symptomatic, clinical manifestations are variable and nonspecific, ranging from a simple abdominal mass to complications related to the size of the spleen. Therefore, Spontaneous rupture of the spleen is an unusual complication.

We report the case of a patient admitted for intense abdominal pain with signs of acute circulatory failure, whereas abdominal ultrasound showed normal size spleen and abdominal effusion, the CT angiography guided the diagnosis by objectifying splenic infarction associated with intra and retro-peritoneal effusions. Splenectomy was urgently performed. Histopathological examination of the surgical specimen showed a congestive spleen, with cystic dilated lymphangiomatous structures of varying sizes.

Keywords: Cystic lymphangioma; circulatory failure; splenectomy

Introduction

The splenic localization of a cystic lymphangioma is an exceptional phenomenon, they are often asymptomatic and accidentally discovered, when they are symptomatic; the clinical presentation is variable and non-specific. Spontaneous rupture of a splenic lymphangioma is an unusual and potentially fatal complication. To our knowledge; only one case is described in the literature by E. Marc et al [1]. In this observation, we report the case of a patient admitted for intense abdominal pain with signs of acute circulatory failure, secondary to a spontaneous rupture of a cystic lymphangioma of the spleen.

Case Report

A 46-year-old woman, her past medical history was unremarkable, presenting to the emergency department with severe abdominal pain of sudden installation during a defecation effort. The physical examination found a patient pale, confused, collapsed; blood pressure was at 60/30 mmHg, weak peripheral pulses and cold extremities with rapid shallow breathing (35 breaths per minute). The abdomen was distended and tender, especially at the left upper quadrant. Laboratory studies showed; hemoglobin 6.8 g/dl, C-reactive protein at 12 mg / l, lactate 3.4 mmol/l, kidney function tests along with serum electrolytes were within normal limits. Given the persistence of hemodynamic instability and neurological disorders despite infusion of 1000 ml of crystalloid solution; the patient was intubated and mechanically ventilated with placement of arterial line and a triple lumen internal jugular central venous catheter, and norepinephrine started at a dose of 2 µg/kg/min. The abdominal ultrasound showed a normalsized spleen with abundant peri-hepatic and peri-splenic effusion, and abdominal CT angiography, performed after hemodynamic optimization, revealed hemoperitoneum with intra and retroperitoneal hematomas associated with splenic infarction (Figure 1). A laparotomy was then carried out in an emergency and found a high-abundance haemoperitoneum with a bleeding originating from the upper-internal part of a normal-sized spleen. .Haemostasis splenectomy was performed (Figure 2).

Citation: Elbouti A, Massad I, Touab R, Andaloussi MR, Chouikh C, Balkhi H. Haemorrhagic Shock Following Spontaneous Rupture of a Cystic Lymphangioma of the Spleen - Case Report. Austin J Anesthesia and Analgesia. 2020; 8(1): 1082.