Medicina

Hassan et al. World Journal of Emergency Surgery 2010, 5:28 http://www.wjes.org/content/5/1/28

WORLD JOURNAL OF EMERGENCY SURGERY

CASE REPORT

Open Access

Unusual case of pancreatic inflammatory myofibroblastic tumor associated with spontaneous splenic rupture
Kamal S Hassan1*, Hector I Cohen2, Fadi K Hassan3, Shadi K Hassan4
Abstract
Background: Spontaneous splenic ruptureconsidered a relatively rare but life threatening. The three commonest causes of spontaneous splenic rupture are malignant hematological diseases, viral infections and local inflammatory and neoplastic disorders. We describe a unique and unusual case of inflammatory myofibroblastic tumor of the tail of pancreas presented with massively enlarged spleen and spontaneous splenic rupture. Casepresentation: A 19 years old male patient with no significant past medical history presented to emergency room with abdominal pain and fatigue. Massively enlarged spleen was detected. Hypotension and rapid reduction of hemoglobin level necessitated urgent laparatomy. About 1.75 liters of blood were found in abdominal cavity. A large tumor arising from the tail of pancreas and local rupture of an enlargedspleen adjacent to the tumor were detected. Distal pancreatectomy and splenectomy were performed. To our knowledge, we report the first case of massively enlarged spleen that was complicated with spontaneous splenic rupture as a result of splenic congestion due to mechanical obstruction caused by an inflammatory myofibroblastic tumor of the tail of pancreas. A review of the literature is alsopresented. Conclusion: Inflammatory myofibroblastic tumor of the tail of pancreas should be included in the differential diagnosis of the etiological causes of massively enlarged spleen and spontaneous splenic rupture.

Introduction The most common causes of splenomegaly are liver diseases (33%), hematologic malignancies (27%), infections (23%), congestion or inflammation (8%), primary splenicdiseases (4%) and others (5%) [1]. Cirrhosis, lymphoma, AIDS and endocarditis, congestive heart failure and splenic vein thrombosis considered the most common causes in each variety - respectively [1]. There are only a few conditions that cause massively enlarged spleen including chronic myeloid leukemia, hairy cell leukemia, lymphoma, myelofibrosis, thalassemia major, visceral leishmaniasis,malaria, tropical splenomegaly syndrome, AIDS with Mycobacterium avium complex and Gaucher disease [2]. Spontaneous splenic rupture considered a relatively rare but life threatening. Recently, Renzulli et al reported a systematic review of 845 cases with
* Correspondence: drkamalh@hotmail.com 1 Clalit Health Services, Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel Full list ofauthor information is available at the end of the article

spontaneous splenic rupture that had been published over more than 28 years [3]. In 84.1 percent of cases a single etiological factor was found. Two underlying pathologies were found in 8.2 percent of cases and three or more etiological factors were found in 0.7 percent of cases. The three commonest causes of spontaneous splenicrupture were malignant hematological diseases, viral infections and local inflammatory and neoplastic disorders. Massively enlarged spleen and spontaneous splenic rupture caused by inflammatory myofibroblastic tumor (IMT) of the tail of pancreas is unusual and had been not reported before.

Case presentation Written informed consent was obtained from the patient for publication of this case report.A 19 years old male patient with no significant past medical history presented to emergency room with abdominal pain and fatigue without complains of anorexia, nausea, vomiting, weight loss, jaundice or fever. Physical examination

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