Spontaneous Splenic Rupture in a Young Patient: A Comprehensive Case Report and Literature Review.

Spontaneous splenic rupture (SSR), a rare but potentially life-threatening condition, typically occurs in the absence of trauma or underlying splenic disease. This report aims to contribute to the limited body of knowledge regarding its occurrence, diagnosis, and management in this demographic. We describe the case of a 20-year-old patient with no significant medical history who presented with acute abdominal pain and hypovolemic shock. Imaging revealed an unexpected splenic rupture without any preceding trauma or identifiable risk factors. The patient's clinical progression, diagnostic challenges, and therapeutic approach are discussed in detail. This case underscores the importance of considering SSR in the differential diagnosis of acute abdomen in young patients, even in the absence of predisposing factors. We review the literature to highlight the epidemiology, possible etiologies, diagnostic modalities, and treatment options for SSR. The peculiarities of managing such cases in young patients are also discussed, emphasizing a tailored approach to balance the risks of conservative management against surgical intervention. In conclusion, SSR, though rare in young patients, should be a diagnostic consideration in cases of unexplained acute abdomen. Early recognition and appropriate management are crucial for favorable outcomes. This case adds to the existing literature by providing insight into the presentation and management of this condition in a young, healthy individual, thereby aiding in enhancing clinical vigilance and patient care.

A Rare Cause Of Acute Abdomen In Middle-Aged Man: Idiopathic Spontaneous Hemoperitoneum.

INTRODUCTION AND IMPORTANCE: Idiopathic spontaneous hemoperitoneum is a rare and often life-threatening condition. It is an uncommon cause of acute abdomen; it represents a real emergency condition and must be considered in any patient with atypical abdominal pain and hemodynamic instability. CASE PRESENTATION: This is a detailed case presentation and non-operative management of idiopathic spontaneous hemoperitoneum with atypical abdominal pain. This is 45-year-old male was admitted with a history of progressive abdominal pain for one year. He denied any history of recent trauma, physical assault, bleeding disorder, or drug abuse. The plain abdominal film was unremarkable, and a computed tomographic scan with intravenous contrast (CT) revealed an intra-peritoneal hemorrhage, while esophagogastroduodenoscopy (EGD) and CT angiography (CTA) revealed no abnormality. The patient was managed non-operatively with a good outcome. Six days later, the patient was discharged with further follow-up in outpatient. The follow-up computed tomographic scan with intravenous contrast revealed complete resolution of the hemoperitoneum, and the patient remained asymptomatic. CLINICAL DISCUSSION: Spontaneous hemoperitoneum is usually the result of an unknown cause in the non-traumatic abdomen. Also, in between 30 and 38 % of documented cases, the source of bleeding could not be determined. The pathogenesis remains unclear. The "double-rupture" phenomenon can explain the clinical deterioration after the initial presentation of the hemodynamically stable. PATIENT: Prognosis is dependent on early diagnosis and intervention. CONCLUSION: Success with non-surgical management of idiopathic spontaneous hemoperitoneum has been reported in limited cases, including the present one.

Evaluating Depression Among Acne Vulgaris Patients Treated With Isotretinoin.

Background Isotretinoin is the most effective treatment for moderate to severe acne. However, isotretinoin has many side effects related to its use. Since 1983, when Hetzen reported the first occurrence of new depressive symptoms in patients treated with isotretinoin, a lot of controversies emerged regarding the causal relationship between isotretinoin and depression. Objective To evaluate depression among acne patients treated with isotretinoin versus doxycycline at King Fahad Hospital of the University between December 2019-March 2020. Methods Using the Global Acne Grading System, patients aged 18 - 30 years old with moderate to severe acne vulgaris who have not received isotretinoin previously and has no personal or family history of any psychiatric illnesses, were evaluated for depression using the patient health questionnaire-9 before starting treatment and 8 weeks after. Twenty-nine patients had met the inclusion criteria and were included in the study. Results Of the 29 patients included, 18 patients completed the study (nine males, nine females). Twelve patients received isotretinoin 0.5mg/kg (study group) and six patients received doxycycline 100mg (control group). The mean depression score for the isotretinoin group has decreased from (4 ± 2.48) to (3.08 ± 2.84) but the result was statistically insignificant with a p-value of 0.19, CI (-5.28, 2.36). For the doxycycline group, the mean depression score has decreased from (5.5 ± 2.5) to (2.83 ± 0.75) with a p-value of 0.043, CI (0.12, 5.21). There was no statistically significant difference in the mean depression score between the two groups after 8 weeks of starting treatment [p-valve 0.837, CI (-2.28, 2.78)]. Conclusion This study showed that, after 8 weeks of starting treatment, isotretinoin at 0.5 mg/kg has no risk of developing depression. The results of this study did not reveal a direct relationship between the use of isotretinoin and the development of depression. Furthermore, optimum control and treatment of acne vulgaris have shown to improve depression scores.