Splenic Rupture in Chronic Myeloid Leukemia: A Rare Hematological Emergency

Résumé fourni par la source

Chronic myeloid leukemia (CML) is a clonal myeloproliferative neoplasm commonly presenting with splenomegaly, constitutional symptoms, and laboratory evidence of leukocytosis. Spontaneous splenic rupture is a rare but potentially fatal initial presentation. We report the case of a 40-year-old male with no prior comorbidities who presented with acute abdominal pain, distention, and vomiting. Clinical examination revealed massive splenomegaly, hypotension, pallor, and absent bowel sounds. Laboratory investigations demonstrated marked leukocytosis (total leukocyte count: 251,300/?L), anemia, and peripheral smear findings consistent with a left shift. Contrast-enhanced CT abdomen revealed massive splenomegaly with parenchymal disruption, large perisplenic hematoma, and hemoperitoneum. Despite fluid resuscitation and transfusion, he remained hemodynamically unstable and underwent emergency splenectomy. Histopathology confirmed leukemic infiltration of the spleen, and bone marrow studies with PCR identified BCR-ABL positivity, confirming CML. Postoperatively, the patient received appropriate vaccinations and was commenced on imatinib, with good clinical response on follow-up. This case underscores the need to consider atraumatic splenic rupture in patients with hematological malignancies presenting with acute abdomen, even without a history of trauma. Early diagnosis, prompt surgical intervention, and targeted therapy for the underlying hematologic disorder are critical to improving outcomes.

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