Spontaneous splenic rupture due to occult signet-ring cell gastric cancer accompanied by a bulky splenic vein thrombosis and postoperative brain infarction: A case report.

Background: Splenic rupture because of metastasis from a distant organ is extremely rare.

Case Presentation: An 80-year-old man presented with left flank pain. A computed tomography (CT) demonstrated a poorly enhanced enlarged spleen with bulky thrombus in the splenic vein without extravasations. A CT on the following day showed increased intraperitoneal hemorrhage; therefore, an emergency laparotomy was performed. The spleen was enlarged and ruptured with lacerations on its surface. Macroscopic examination showed congestion with a thrombus in the splenic vein around the hilum. Pathology revealed signet-ring cell carcinoma. On the third postoperative day, a massive cerebral infarction in the left middle cerebral artery was revealed. Endoscopic examination demonstrated normal gastric mucosa except for some erosions, for which biopsies were performed, and two of five specimens encompassed signet-ring cell carcinoma in the lamina propria.

Conclusion: Occult cancer could result in a drastic manifestation of its metastasis accompanying systemic thrombotic events.