Non-traumatic Rupture of the Spleen. Can Splenectomy be Applied Selectively?
Non-traumatic Rupture of the Spleen. Can Splenectomy be Applied Selectively?
Purpose: Non-traumatic rupture of the spleen should be suspected when patients (especially
 young men) present with abdominal pain and a history of acute infectious or
 myeloproliferative disorders. Preoperative imaging studies in hemodynamically stable patients
 may obviate the need for surgery even in the presence of massive hemoperitoneum. The purpose
 of this research is to inform acute management where spontaneous rupture is suspected in
 order to avoid surgery where appropriate, rationalise angiographic intervention and blood
 transfusion.

 Hypothesis: Indentifying the cause of injuries can help target preventative intervention.

 Background: Non-traumatic rupture of the spleen is a rare condition. It may occur in the
 diseased spleen secondary to a variety of pathologies including malaria and
 myeloproliferative disorders. In some cases rupture may occur in an apparently normal spleen.
 The incidence, symptoms, causes, therapy and prognosis are poorly defined. The investigators,
 therefore, propose an extension of retrospective analysis conducted, presented and published
 in 2003 to examine all the cases of non-traumatic splenic rupture treated at Ziv Medical
 Centre from the last 26 years to present.

 Methods: Analysis of the medical notes of all patients with spontaneous splenic rupture in
 the medical archives.

 The investigators hope to determine the true incidence of this condition within the local
 population, increasingly diverse in origin, travel and the incidence of predisposing
 infectious disease; and to devise a practical protocol in their safe diagnosis and
 management, especially as non-operative interventions have grown in safety and effectiveness.

 Discussion: Although rare, spontaneous splenic rupture may be fatal if not suspected or
 treated inappropriately. Understanding the pitfalls in diagnosis and management better
 informs decision making towards improved care of these patients.
Non-traumatic rupture of the spleen is a rare condition. It may occur in the diseased spleen
 should be suspected when patients (especially young men) present with abdominal pain and a
 history of acute infectious or myeloproliferative disorders. Rarely, rupture may occur within
 an apparently normal spleen. The incidence, symptoms, causes, therapy and prognosis are
 poorly defined. We, therefore, propose an extension of retrospective analysis already
 presented in 2003 to examine all the cases of non-traumatic splenic rupture treated at Ziv
 Medical Centre over the last 26 years and to rationalise treatment plans taking into
 consideration pitfalls and complications in management so that the care and outcome for these
 patients is improved.

 Methods:

 Patients with a diagnosis of non-traumatic splenic rupture will be identified from the
 hospital database, their medical records retrieved and analysed to determine their actual
 diagnosis and examine their management and outcomes.

 Time frame:

 The retrospective data over the last 26 years will be analysed over the next year.

 Endpoints:

 This is a retrospective study. Our records indicate that as non-traumatic splenic rupture is
 a rare diagnosis, there are fewer than 50 patients listed with this diagnosis, fewer still,
 where examination of the medical records will reveal this to be the actual diagnosis.

 Inclusion criteria:

 All patients where review of the medical records indicates non-traumatic rupture of the
 spleen.

 Exclusion criteria:

 Patients with antecedent trauma. Statistical analysis: Data will be subjected to statistical
 analysis using IBM SPSS and incremental risk calculator software.

 Budget: not needed

 Ethics:

 This study focuses only on the analysis of medical records. Supplementary information from
 patients and health care staff will not be collected. There are no interviews or
 questionnaires planned and data nor treatment outcomes will be discussed outside the context
 of scientific debate (including presentation and publication).
Inclusion Criteria:

 -  All patients where review of the medical records indicates non-traumatic rupture of
 the spleen.

 Exclusion Criteria:

 -  Patients with antecedent trauma.