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Milzruptur

Klinisch-pathologische Zusammenhänge und Diagnostik

Rupture of the spleen

Clinicopathological correlations and diagnostic procedures

  • Schwerpunkt: Pathologie der Milz
  • Published:
Der Pathologe Aims and scope Submit manuscript

Zusammenfassung

Obwohl selten, stellen Milzrupturen die häufigste Splenektomieindikation dar. Bei der überwiegenden Mehrzahl der Fälle (traumatische Rupturen) lässt sich eine klare Kausalität mit Gewalteinwirkung feststellen, bei einem anderen Teil (pathologische Rupturen) liegt eine Vorerkrankung der Milz vor, bei einem kleinen Teil der Patienten (spontane Rupturen) lässt sich kein Zusammenhang mit Traumen oder anderen Grunderkrankungen eruieren. Bei etwa 10% der rupturierten Milzen ist mit Iatrogenie im weitestem Sinne (inklusive Medikamentennebenwirkungen) sowie mit relevanten pathologischen Befunden (die Hälfe davon unerwartet) zu rechnen. Kenntnisse der Pathophysiologie, die Erhebung einfacher makroskopischer Befunde wie Größen- und Gewichtsangaben und Angaben sichtbarer Läsionen sowie die sorgfältige histologische Analyse mit gezielter Suche nach wegweisenden Veränderungen, ggf. unter Anwendung histo- und immunhistochemischer Zusatzuntersuchungen am gut vorbereiteten Material, sind die Schlüssel zur adäquaten Diagnostik.

Abstract

Though rare, splenic rupture is the most common indication for splenectomy. In the vast majority of cases ruptures are clearly related to trauma (traumatic ruptures); in other cases there is a pre-existing disease affecting the spleen (pathologic ruptures); and in a minority of patients no obvious reason can be identified (spontaneous ruptures). In approximately 10% of cases an iatrogenic cause, in the broadest sense (including side effects of drugs), and relevant histological findings (approximately half of which will be unexpected) can be anticipated. Knowledge of pathophysiological aspects of splenic rupture and assessment of simple macroscopic findings such as splenic dimensions and weight, and information on macroscopically visible lesions are of key diagnostic importance, as is accurate microscopic examination with targeted histological pattern analysis, supplemented as appropriate by histo- and immunohistochemical studies on adequately prepared material.

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Authors and Affiliations

  1. Institut für Pathologie, Universitätsspital, Schönbeinstraße 40, 4031, Basel, Schweiz

    A. Tzankov & H. Adams

  2. Institut für pathologische Anatomie, Medizinische Universität, Innsbruck, Österreich

    W. Sterlacci

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  1. A. Tzankov
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  2. H. Adams
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  3. W. Sterlacci
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Correspondence to A. Tzankov.

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Tzankov, A., Adams, H. & Sterlacci, W. Milzruptur. Pathologe 29, 148–157 (2008). https://doi.org/10.1007/s00292-007-0948-0

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  • DOI: https://doi.org/10.1007/s00292-007-0948-0

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