Can i ruptured my spleen by coughing

With the spleen fully mobilized, the splenic vessels were taken between clamps and ligated. The artery was always ligated before the vein. Any remaining short gastric vessels or other attachments were divided, freeing the spleen from the abdomen. Once the spleen was out, attention was placed to accessory spleen remnants. There were isolated pockets in the splenorenal ligament which were taken out by blunt dissection.

The wound bed was thoroughly irrigated with warm saline till the return was clear. Fibrillar and avitene local hemostatic agents were placed in the splenic bed.

The abdomen was closed in layers with maxon for fascia followed by vicryl for subcutaneous and the skin was closed with staples. The patient tolerated the surgery well. Pathological study showed benign spleen with congestion along with fragments of hematoma. There was no definitive morphologic or phenotypic evidence for lymphoproliferative disorder.

The patient made an uneventful recovery and was discharged home on postoperative day 7. Three vaccines were given before she left: the pneumococcal polyvalent vaccine, hemophilus B vaccine, and meningococcal polysaccharide vaccine.

The patient presented to the ED 9 days following discharge with chest pain in her left back area that began the night before. A CT scan of the chest was performed with IV contrast, which demonstrated the presence of left-sided subsegmental pulmonary emboli with moderate left pleural effusion.

The patient was started on lovenox for the pulmonary emboli and had a chest tube placed to drain the pleural effusion. She was discharged home 5 days later. Spontaneous rupture of the normal spleen is a very rare occurrence. In a comprehensive review article published in by Aubrey-Bassler and Sowers [ 4 ], there were only 12 reported cases of spontaneous rupture of the normal spleen after coughing in English and French literature on human subjects between and [ ]. For non-traumatic rupture of the spleen, the most common etiologies are infections, neoplasia and connective tissue disease [ 1 ].

The common causes of infiltrative or inflammatory pathology are malaria, mononucleosis, CMV, typhoid fever, endocarditis with splenic embolism, pneumonia, viral hepatitis, etc. Some of the commonly attributed rheumatologic causes are Wegeners granulomatosis, polyarteritis nodosa, systemic lupus erythematosus, amyloidosis, etc.

There have been also 38 cases of pregnancy-related rupture of normal spleen reported. There have also been previously undiagnosed non-hematological neoplastic causes of spontaneous rupture of spleen reported; the common causes cited are angiosarcoma, choriocarcinoma, pancreatic cancer, lung cancer, etc. Spontaneous splenic ruptures are also caused by anticoagulation, thrombolytics, recombinant granulocyte-colony stimulating factor, and anti-platelet agents [ 4 ].

The review article published by Aubrey-Bassler and Sowers [ 4 ] mentioned four case reports of spontaneous rupture of spleen following vomiting [ 1 , ], and one case report following seizure [ 20 ]. There have also been case reports of spontaneous rupture of spleen following colonoscopy, endoscopic retrograde cholangiopancreatography, hepatic and pulmonary surgery and even emission computed tomography, laparoscopy and hysterectomy [ 4 ]. A case of spontaneous splenic rupture was first described in by Atkinson, a British surgeon [ 21 ].

His publication triggered a number of similar case report publications eventually leading to the comprehensive review article in [ 22 ]. Orloff and Peskin recognized four-step criteria for the diagnosis of spontaneous rupture consisting of no trauma history, no perisplenic adhesions that may support previous trauma, no disease affecting the spleen, and presence of a normal spleen on gross and histologic examinations [ 22 ]. In the same review article, they cited 71 cases termed as spontaneous splenic rupture of which only 20 met all of the criteria previously mentioned.

Crate and Payne added a fifth criterion: Full virological studies of acute phase and convalescent sera should show no significant rise in antibody titers suggesting recent viral infection of types known to be associated with splenic involvement [ 23 ].

The clinical picture of traumatic rupture and non-traumatic rupture of the spleen are identical. The spleen is normal on gross and microscopic examination with rupture and bleeding.

The common clinical presentation is hypovolemic shock along with signs of peritonitis [ 13 , 24 ]. Upper left abdominal pain was caused by diaphragmatic irritation causing referred pain to the left shoulder Kehr sign and Balance sign palpable painful mass may be felt in the LUQ. Other associated clinical findings may include nausea, vomiting, dizziness, or syncope. When a splenic rupture is suggested, ultrasound may be used as the first step in imaging studies. It is now considered the best initial imaging method for unstable patients [ 25 ].

Besides being operator-dependent, the FAST sometimes fails to detect fluid volumes less than - mL. What does the spleen do? The spleen has some important functions: it fights invading germs in the blood the spleen contains infection-fighting white blood cells it controls the level of blood cells white blood cells, red blood cells and platelets it filters the blood and removes any old or damaged red blood cells Spleen problems The spleen is not working properly If the spleen does not work properly, it may start to remove healthy blood cells.

This can lead to: anaemia , from a reduced number of red blood cells an increased risk of infection, from a reduced number of white blood cells bleeding or bruising, caused by a reduced number of platelets A painful spleen Spleen pain is usually felt as a pain behind your left ribs. This can be a sign of a damaged, ruptured or enlarged spleen. A damaged or ruptured spleen The spleen can become damaged or may burst rupture after an injury, such as a blow to the abdomen, a car accident, a sporting accident or broken ribs.

Rupture can happen straight away or it may happen weeks after the injury. Signs of a ruptured spleen are: pain behind your left ribs and tenderness when you touch this area dizziness and a rapid heart rate a sign of low blood pressure caused by blood loss Sometimes if you lie down and raise your legs, you can feel the pain at the tip of your left shoulder.

A ruptured spleen is a medical emergency, as it can cause life-threatening bleeding. An enlarged spleen The spleen can become swollen after an infection or injury. An enlarged spleen does not always cause symptoms. Otherwise, look out for: feeling full very quickly after eating an enlarged spleen can press on the stomach feeling discomfort or pain behind your left ribs anaemia and fatigue frequent infections easy bleeding Doctors can often tell if you have an enlarged spleen by feeling your abdomen.

Surgery to remove the spleen You may need an operation to remove your spleen, known as a splenectomy, if it's not working properly or it's damaged, diseased or enlarged. Sometimes just part of your spleen can be removed, which is called a partial splenectomy.

Laparoscopy Most operations to remove spleens are carried out using keyhole surgery laparoscopy. The procedure involves: making several small cuts in your tummy guiding a laparoscope into your body through one of the cuts so doctors can see what they're doing passing thin instruments into your tummy through the other cuts to remove your spleen gas will be pumped into your tummy to make this easier The cuts are then stitched up or sometimes glued together.

You may be able to go home the same day, or you may need to stay in hospital overnight. If you go home the same day, someone will need to stay with you for the first 24 hours. Open surgery Open surgery is where one large cut is made. Recovering from spleen surgery It's normal to feel sore and be bruised after a splenectomy, but you'll be given pain relief. You should be able to eat and drink as normal soon after the operation. Your doctor will talk through these risks with you. Living without a spleen If your spleen needs to be removed, other organs, such as the liver, can take over many of the spleen's functions.

Young children have a higher risk of serious infection than adults, but the risk is still small. This risk can be minimised by following simple precautions to prevent infection. You should also be vaccinated against: pneumococcal infections, such as pneumonia, with a booster every 5 years flu get the flu vaccine every year MenACWY MenB Antibiotics It's recommended that you take low-dose antibiotics for the rest of your life to prevent bacterial infections.

Antibiotics are particularly important: for children under the age of 16 for the first 2 years after your spleen is removed if your immune system does not work properly Be alert for signs of infection See a GP as soon as possible if you get signs of an infection. Signs of infection include: a high temperature a sore throat a cough a severe headache a headache with drowsiness or a rash abdominal pain redness and swelling around the surgical wound Your GP can prescribe a course of antibiotics for you to use if you get an infection.

If your infection becomes serious, you may be admitted to hospital. However, symptoms may be atypical and the condition may imitate acute coronary ischemia, pulmonary embolism, peptic ulceration, and pneumonia [ 2 ]. Abdominal examination usually discloses peritoneal irritation and acute hemorrhage [ 6 ]. Initial laboratory work-up may show normal or low hemoglobin levels [ 6 ].

Ultrasound and computed tomography have been reported to be the most useful imaging diagnostic tools [ 6 ]. In regard to the management, splenectomy is the preferred surgical option [ 9 ]. However, in haemodinamically stable patients there is a trend towards a nonoperative management in order to minimize the risk of postsplenectomy infection [ 9 ]. Cough and vomiting are rarely reported causes of spontaneous rupture of a histologically normal spleen [ 10 ].

In regard to the pathophysiological mechanism, it has been reported that coughing results in a forceful contraction of the abdominal muscles which subsequently press the diaphragm and the abdominal organs upwards leading to a squeeze of the spleen and injury of the splenic capsule [ 6 ].

Since a definitive etiology was not recognized, cough in the course of the respiratory infection could be the most possible trigger factor of the splenic rupture, since the condition is frequently undiagnosed which highlights the necessity of a high level of vigilance from the part of emergency physicians when they face patients with atypical symptoms and no other predisposing pathologies.

Early diagnosis and surgical intervention are essential in order to avoid serious fatal complications. Written informed consent was obtained from the patient for publication of this case report and accompanying images.

This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors.

Read the winning articles. Journal overview. Academic Editor: Serge Landen. Received 28 Jan Accepted 05 Jun Published 19 Jun Abstract Atraumatic rupture of a normal spleen represents a rare clinical phenomenon.

Introduction Spontaneous rupture of a histologically normal spleen is a rare clinical occurrence with fatal complications if not early diagnosed [ 1 , 2 ]. Case Presentation A year-old previously healthy Greek male was referred by his general practitioner to the Emergency Department of the Saint George General Hospital of Chania, Crete, complaining of a sharp lower hemithoracic pain exacerbated by cough and movement as well as high fever up to 40 grades Celsius.

Figure 1. Chest X-ray showing left lobar consolidation. Figure 2. Axial computed tomography of the abdomen showing a ruptured spleen and haemoperitoneum. References D. Debnath and D. View at: Google Scholar K.