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A 26-year-old male was returning from a neighborhood store with a six-pack of beer. He attempted to run across a busy street but was struck by a car. He was fully conscious at the scene, complaining of pain in his abdomen and left leg. Examination by paramedics revealed an open fracture of the left tibia with moderate bleeding, left upper quadrant pain with rebound tenderness, and a fast, weak pulse. The leg was immobilized, oxygen was administered, an IV started, and he was transported to the Trauma Center, approximately 10 minutes away. About 3 minutes before arriving at the Trauma Center, he suffered cardiopulmonary arrest from which he could not be resuscitated, despite vigorous advanced life support.
At autopsy, his stomach was found to be full of beer, along with 4 whole wieners (without any teeth marks!). His spleen, which is normally about the size of the patient’s fist, was grossly enlarged: it measured from just under the diaphragm to the level of the umbilicus, and from the ventral midline to the mid-axillary line. The spleen was torn in multiple sites, from which the patient had sustained substantial blood loss that was found free in his abdomen.
What is the cause of death?
What is the most likely cause of such massive splenomegaly?
What other organ do you think was also diseased? Why?
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