Spontaneous Splenic Hemorrhage Leading to Diagnosis of Metastatic Adenocarcinoma of Unknown Origin.

Abstract

Introduction: Spontaneous splenic hemorrhage is a rare initial presentation of malignancy. The objective of this case report is to elucidate the complexities of early diagnosis of splenic metastases and the complications associated with advanced malignancies of the spleen. It is also a reminder to consider splenic metastases and hemorrhage in the differential diagnosis for nonspecific presentations, such as acute abdomen, in adults.

Case presentation: A 58-year-old female with 1 month of vague, worsening systemic symptoms and computed tomography findings suspicious for a subcapsular splenic hematoma was found to have splenic rupture. After undergoing emergency laparotomy with splenectomy, pathological samples revealed metastatic poorly differentiated adenocarcinoma of unknown origin. During a subsequent admission, she was found to be hemodynamically unstable, deemed a poor candidate for inpatient chemotherapy, and elected to proceed with comfort measures after which she died from multiorgan failure 3 weeks after initial presentation.

Discussion: Spontaneous (nontraumatic) splenic hemorrhage secondary to metastasis should remain a differential diagnosis for patients with acute abdomen and associated risk factors for primary malignancies.