Nontraumatic splenic rupture during body boarding

Ken-Ichi Muramatsu1, Yuta Murai2, Mutsumi Sakurada2, Youichi Yanagawa1
1 Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Izunokuni, Japan
2 Department of Surgery, Shizuoka Hospital, Juntendo University, Izunokuni, Japan

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Date of Submission06-Nov-2021Date of Acceptance23-Nov-2021Date of Web Publication27-Jun-2022 How to cite this article:
Muramatsu KI, Murai Y, Sakurada M, Yanagawa Y. Nontraumatic splenic rupture during body boarding. J Emerg Trauma Shock 2022;15:111-2

Sir,

Splenic rupture (SR) is classified into traumatic and nontraumatic types. Most cases of SR involve a traumatic etiology, and nontraumatic SR (NSR) is extremely rare. In addition, NSR is classified into spontaneous rupture, in which the spleen has a normal histology, and pathologic rupture, which occurs in a diseased spleen.[1] Infection, malignancy, metabolic disorders, vascular, hematological diseases, and congenital or structural abnormality cause disease of the spleen.[1] Three mechanisms are involved in the process: increased intrasplenic tension linked to cell hyperplasia and engorgement; compression by the abdominal muscles during sneezing, coughing, or defecating; and vascular occlusion by hyperplasia of the endothelial reticulum responsible for infarction that is associated or not associated with subcapsular hematoma.[2]

A 21-year-old male felt abdominal-back pain when his spine become hyperextended (dorsal flexion) after being knocked by waves during bodyboarding. The waves did not directly impact his abdomen. Significant wave height was 1.5 m. As he could not stand due to pain, an ambulance was called. The fire department suspected a bodyboarding injury and requested the dispatch of a physician staffed helicopter (PH).[3] He had received thoracotomy to repair a ventricular septal defect when he was 5 years of age. He had no specific family history. When the PH staff checked him, his complaint was right flank pain. He did not have any abrasions or hematomas. His vital signs were as follows: consciousness, clear; blood pressure, 76/58 mmHg; heart rate, 100 beats per minute; respiratory rate, 18 breaths per minute; and percutaneous saturation (SpO2), 99% under room air. Abdominal echo showed an abnormal area in the spleen with an echo free space between the spleen and kidney. He received a lactate ringer fluid infusion. After arrival, truncal-enhanced computed tomography showed SR with mild splenomegaly and intra-abdominal bleeding [Figure 1]. He had a minor inflammatory response (leukocytosis and a minor increase in C-reactive protein [CRP]). He was diagnosed with SR with a hemorrhagic shock state. He underwent splenectomy. The postoperative course was uneventful. He was discharged on the 6th hospital day. A pathological examination showed only hematoma and congested spleen.

Figure 1: Enhanced computed tomography on arrival. Computed tomography showed splenic rupture with intra-abdominal hemorrhage

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This is a rare case of NSR and the first case to occur during bodyboarding. In the present case, we considered that the splenomegaly due to young age and/or preceding viral infection were factors that could have induced NSR. A minor increase in CRP may suggest a viral infection, even if the patient was asymptomatic.[4] Another factor involved in the induction of NSR was bodyboarding. This would have indirectly impacted the spleen due to muscle contraction of the abdominal wall, which would have occurred when the spine was in dorsal flexion. We could not find any previous reports that showed a relationship between NSR and previous thoracotomy.

The present case showed right flank pain when the PH staff checked him. This may be due to the presence of right abnormal small intestine gas due to paralysis of the left side of the small intestine due to SR.[5]

Declaration of patient consent

We certify that we have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Research quality and ethics statement

We followed applicable EQUATOR Network (http://www. equator-network. org/) guidelines, notably the CARE guideline, during the conduct of this report.

Financial support and sponsorship

This work was supported in part by a Grant-in-Aid for Special Research in Subsidies for ordinary expenses of private schools from the Promotion and Mutual Aid Corporation for Private Schools of Japan.

Conflicts of interest

There are no conflicts of interest.

References

1.Renzulli P, Hostettler A, Schoepfer AM, Gloor B, Candinas D. Systematic review of atraumatic splenic rupture. Br J Surg 2009;96:1114-21.

2.Ahbala T, Rabbani K, Louzi A, Finech B. Spontaneous splenic rupture: Case report and review of literature. Pan Afr Med J 2020;37:36.

3.Omori K, Kondo A, Oode Y, Itoi A, Sakuraba K, Yanagawa Y. Analysis of patients with bodyboarding injuries transported by physician-staffed emergency helicopter. J Emerg Trauma Shock 2015;8:39-42.

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