Diagnosis: Atraumatic splenic rupture (ASR)
Atraumatic splenic rupture also referred to as ASR, is a serious life-threatening medical condition that is usually associated with trauma or severe injury. As mentioned by Tonolini et al. (2016), this illness is uncommon; however, there is a large amount of research and thousands of case reports on the topic. The main symptoms of atraumatic splenic rupture are left abdominal pain, tenderness during palpation, and high levels of distress, confusion, or dizziness (Tonolini et al., 2016). Due to the fact that this kind of rupture is not connected to an injury, medical specialists differentiate its various causes. Some of the contributing factors are inflammatory disease, infections, the use of certain drugs, and malaria (Tonolini et al., 2016). Even though automatic splenic rupture puts individuals at a high risk of death, early diagnosis and appropriate treatment can lead to success.
Differential Diagnoses
One of the possible differential diagnoses for atraumatic splenic rupture is mononucleosis. Medical specialists can give their patients this diagnosis because mononucleosis has similar symptoms to ASR. At the earliest stage, individuals can experience severe abdominal pain, extreme fatigue, and distress. In addition, since splenic rupture is usually associated with trauma, that was not the case of the discussed patient, doctors can think that the condition is related to a specific infectious illness. However, since the person did not suffer from rash, high fever, headache, and swollen lymph nodes, the mononucleosis diagnosis was excluded from the list of possible conditions.
The second differential diagnosis for atraumatic splenic rupture is abdominal cancer. Judging from the age, family history of cancer, and the patient’s individual conditions, the doctors had to take abdominal tumors into consideration. Some of the signs of abdominal cancer include pain in different areas of the stomach, nausea, and a constant sense of fullness (“Signs and symptoms of stomach cancer,” n.d.). Even though the patient is at risk of developing cancer, specialists had to exclude this option because the signs appeared just two hours ago and did not cause any cancer-related symptoms except for the pain.
Another diagnosis that could be given instead of atraumatic splenic rupture is abdominal compartment syndrome. As explained by Rogers and Garcia (2018), this health condition is the final point of the process when rapid swelling in the area of the abdomen leads to pathologically high pressure. This illness is characterized by difficulty breathing, confusion, and distress, severe abdominal pain, and results in organs dysfunction and death (Rogers & Garcia, 2018). However, the diagnosis was excluded since other necessary symptoms were absent and the signs were experienced for a short period of time.
Treatment Plan
After conducting an abdominal CT and assigning the patient with the right diagnosis, the clinic had to observe the patient and find a facility that would be willing to perform transcatheter embolization. This procedure was essential since its main purpose is to stop the flow of blood from the vessels into the stomach area (Walker & Foley, 2016). The medical specialists indicated that once the surgery is performed, the patient has to remain under close monitoring and stay in the hospital for as long as needed in order to avoid any complications (Walker & Foley, 2016). Surgical operation with constant observation is the most effective way to treat a patient with atraumatic splenic rupture.
Patient Education
The patient was informed about his medical condition and all its distinguishing features. Since he had to go through an operation it was vital to engage in open communication with him and talk about all the possible complications and results of the treatment. In addition, the individual had to be educated for the purpose of preparing for the treatment emotionally and communicating with his relatives about the condition. The patient was instructed to follow the procedure and trust the doctors in the medical facility he was transformed to after the CT.
Prognosis
Atraumatic splenic rupture is a life-threatening condition. For this reason, once the diagnosis was confirmed, it was critical to create an appropriate treatment for the patient and transform him to a facility that can perform a surgical operation for his condition. One of the advantages of this case is that the patient went to the emergency department just a few hours after the symptoms occurred. This action gave a possibility to diagnose him early which means that there is a higher chance that the treatment will lead to success.
Follow-Up
After the operation and the 24-hour management, the patient was recommended to follow up with his oncologist in order to exclude or confirm the cancer-related problem that lead to the splenic rupture. He was informed that it is important to find the cause of the condition in order to prevent the appearance of other problems in the future. The patient followed the recommendations and scheduled a meeting with his doctor.
References
Rogers, W. K., & Garcia, L. (2018). Intraabdominal hypertension, abdominal compartment syndrome, and the open abdomen. Chest, 153(1), 238-250. Web.
Signs and symptoms of stomach cancer. (n.d.). American Cancer Society. 2020, Web.
Tonolini, M., Ierardi, A. M., & Carrafiello, G. (2016). Atraumatic splenic rupture, an underrated cause of acute abdomen. Insights into Imaging, 7(4), 641-646. Web.
Walker, A. M., & Foley, E. F. (2016). Surgical management of atraumatic splenic rupture.
International Surgery Journal, 3(4), 2280-2288. Web.