SHM Converge Scientific Abstract ePoster Gallery-Spontaneous Splenic Hemorrhage Leading to Diagnosis of Metastatic Adenocarcinoma

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This case describes a 58-year-old woman with a history of severe Crohn’s disease, tobacco use, and right kidney atrophy who presented with one month of worsening weakness, malaise, diaphoresis, abdominal distension, left upper quadrant tenderness, and anasarca. Her hospital course rapidly deteriorated when she became unresponsive in respiratory arrest and required intubation.<br /><br />A stat CT scan showed splenomegaly with heterogeneous attenuation and hyperdense perisplenic fluid, concerning for spontaneous subcapsular splenic hematoma. She underwent emergency laparotomy and splenectomy. Pathology unexpectedly revealed metastatic, poorly differentiated adenocarcinoma with signet ring cell morphology, with the primary site initially unknown.<br /><br />After stabilization, she was extubated, and her white blood cell count slowly improved, though her course was complicated by acute kidney injury requiring bilateral ureteral stents. She was discharged with oncology follow-up planned for further evaluation of the cancer source.<br /><br />Nineteen days later, she returned with worsening dyspnea and jaundice. Imaging revealed a pancreatic mass with biliary obstruction. Although pancreatic adenocarcinoma was initially suspected, oncology later considered a small bowel or colon primary more likely. She ultimately died from multiorgan failure due to stage IV metastatic adenocarcinoma of unknown origin.<br /><br />The report emphasizes that spontaneous splenic hemorrhage or rupture is a rare but important complication of metastatic malignancy and may be the first sign of an undiagnosed cancer. It should be considered in middle-aged and older adults presenting with acute abdominal symptoms.

Asset Subtitle

Morgan I. Lucero

Meta Tag

Author List Abhijai Singh, Jordan Palmer, Morgan I. Lucero, Shivani Kumar

Category Clinical Vignettes

Concept Spontaneous Splenic Hemorrhage

Concept Metastatic Adenocarcinoma

Concept Subcapsular Splenic Hematoma

Concept Splenic Metastasis

Concept Acute Abdominal Symptoms

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Morgan I. Lucero

Track Adult

Keywords

Crohn’s disease

spontaneous splenic hemorrhage

splenectomy

metastatic adenocarcinoma

signet ring cell carcinoma

unknown primary cancer

pancreatic mass

biliary obstruction

acute kidney injury

multiorgan failure

Spontaneous Splenic Hemorrhage

Metastatic Adenocarcinoma

Subcapsular Splenic Hematoma

Splenic Metastasis

Acute Abdominal Symptoms