RESUMO
Diagnostic routine and knowledge about the therapy regimes of infectious diseases like malaria gain in importance due to globalization, global warming, and increasing numbers of refugees. We report a case of a 66-year-old patient who presented with severe abdominal pain, most prominent in the left upper abdomen. He was recently hospitalized with severe falciparum malaria, diagnosed after returning from a trip around the world. Upon readmission, laboratory results showed post-artesunate delayed hemolysis. The ultrasound examination was highly suspicious of splenic rupture, confirmed by the immediately performed CT scan. In this case, the prompt diagnosis allowed the initiation of adequate conservative therapy including intensive care monitoring and hemodynamic stabilization.
Assuntos
Ruptura Esplênica , Humanos , Idoso , Ruptura Esplênica/etiologia , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/terapia , Masculino , Malária Falciparum/diagnóstico , Malária Falciparum/complicações , Diagnóstico Diferencial , Artesunato/uso terapêutico , Tomografia Computadorizada por Raios X , Ultrassonografia , Viagem , Resultado do Tratamento , Antimaláricos/uso terapêutico , Ruptura EspontâneaRESUMO
A systemic lupus erythematosus (SLE) patient in her mid-30s presented with spontaneous splenic haematoma and rupture. She rapidly deteriorated despite packed red cells and fresh frozen plasma transfusions. She underwent emergent ultraselective angioembolisation of the splenic artery and got stabilised. Spontaneous or atraumatic splenic rupture is rare in SLE and splenic artery embolisation may be life-saving.
Assuntos
Embolização Terapêutica , Lúpus Eritematoso Sistêmico , Artéria Esplênica , Ruptura Esplênica , Humanos , Lúpus Eritematoso Sistêmico/complicações , Feminino , Embolização Terapêutica/métodos , Ruptura Esplênica/etiologia , Ruptura Esplênica/terapia , Adulto , Ruptura Espontânea , Hematoma/etiologia , Hematoma/terapiaRESUMO
Traumatic splenic rupture is rare in pregnant women; and multiple venous thromboses of the portal vein system, inferior vena cava and ovarian vein after caesarean section and splenectomy for splenic rupture has not been previously reported. This case report describes a case of multiple venous thromboses after caesarean section and splenectomy for traumatic splenic rupture in late pregnancy. A 34-year-old G3P1 female presented with abdominal trauma at 33+1 weeks of gestation. After diagnosis of splenic rupture, she underwent an emergency caesarean section and splenectomy. Multiple venous thromboses developed during the recovery period. The patient eventually recovered after anticoagulation therapy with low-molecular-weight heparin and warfarin. These findings suggest that in patients that have had a caesarean section and a splenectomy, which together might further increase the risk of venous thrombosis, any abdominal pain should be thoroughly investigated and thrombosis should be ruled out, including the possibility of multiple venous thromboses. Anticoagulant therapy could be extended after the surgery.
Assuntos
Cesárea , Esplenectomia , Ruptura Esplênica , Trombose Venosa , Humanos , Feminino , Trombose Venosa/etiologia , Trombose Venosa/cirurgia , Trombose Venosa/tratamento farmacológico , Adulto , Ruptura Esplênica/etiologia , Ruptura Esplênica/cirurgia , Ruptura Esplênica/diagnóstico , Gravidez , Cesárea/efeitos adversos , Período Pós-Parto , Anticoagulantes/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Varfarina/uso terapêuticoRESUMO
A 48-year-old male was admitted to Peking Union Medical College Hospital presented with intermittent fever for two years. The maximum body temperature was 39 â, and could spontaneously relieve. The efficacy of antibacterial treatment was poor. He had no other symptoms and positive signs. He had a significant weight loss, and the serum lactate dehydrogenase increased significantly. It was highly alert to be lymphoma, but bone marrow smear and pathology, and PET-CT had not shown obvious abnormalities. Considering high inflammatory indicators, increased ferritin and large spleen, the patient had high inflammatory status, and was treated with methylprednisolone. Then the patient's body temperature was normal, but the platelet decreased to 33×109/L. During hospitalization, he had suddenly hemoperitoneum and hemorrhagic shock. He was found spontaneous spleen rupture without obvious triggers, and underwent emergency splenectomy. The pathological diagnosis of spleen was diffuse large B-cell lymphoma.
Assuntos
Febre de Causa Desconhecida , Hemoperitônio , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Humanos , Masculino , Pessoa de Meia-Idade , Febre de Causa Desconhecida/etiologia , Febre de Causa Desconhecida/diagnóstico , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Hemoperitônio/etiologia , Hemoperitônio/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Esplenectomia , Baço/diagnóstico por imagem , Ruptura Esplênica/diagnóstico , Ruptura Esplênica/etiologiaRESUMO
Hematopoietic hormones such as granulocyte-colony stimulating factors are commonly used prevent neutropenia in patients undergoing chemotherapy and to prepare patients for bone marrow donations. In rare cases, splenic injury can result from exposure to this medication. We present the case of a 30-year-old man who presented to the emergency department the day after a bone marrow donation procedure complaining of severe, acute onset left upper quadrant abdominal pain, radiating to the shoulder. Neither the patient nor his family reported any abdominal trauma prior to or following the marrow donation procedure. An initial bedside ultrasound examination was positive for peritoneal fluid and distortion of the normal splenic architecture, raising suspicion for possible intraabdominal or splenic injury. An emergent confirmatory CT with contrast of the abdomen confirmed the initial ultrasound examination suspicion of an atraumatic splenic rupture and with evidence of venous bleeding but without active arterial extravasation. An emergent trauma surgery consultation was placed, and he underwent embolization with an uneventful recovery. This case report highlights the need for a high index of suspicion for atraumatic splenic rupture in patients exposed to these types of granulocyte-colony stimulating factors.
Assuntos
Fator Estimulador de Colônias de Granulócitos , Ruptura Esplênica , Humanos , Masculino , Ruptura Esplênica/induzido quimicamente , Ruptura Esplênica/etiologia , Ruptura Esplênica/diagnóstico por imagem , Adulto , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Tomografia Computadorizada por Raios X , Embolização Terapêutica/métodos , UltrassonografiaRESUMO
Isolated splenic peliosis is an extremely rare condition characterized by the presence of multiple blood-filled cavities, occasionally resulting in non-traumatic splenic rupture with fatal bleeding. In our case, a 64-year-old man was brought by ambulance due to weakness and abdominal pain without nausea or febrility. On clinical examination, the patient was sensitive to palpation with significant tenderness over the abdomen but no associated features of peritonitis. He collapsed during the imaging examination and became unconscious and asystolic. Cardiopulmonary resuscitation was not successful. The patient died approximately within 2 hours of admission to the hospital. Postmortal examination showed 2800 ml of intraperitoneal blood with clots and a laceration of the lower pole of the spleen. Macroscopic examination of the spleen revealed huge nodular splenomegaly, measuring 21 cm x 19 cm x 5 cm, weighing 755 g. On the cut surfaces, multiple randomly distributed blood-filled cavities ranging from 0,5 to 2 cm in diameter were seen. At microscopic examination, the specimens showed multiple irregular haemorrhagic cyst-like lesions that were not lined by any epithelium or sinusoidal endothelium, consistent with the diagnosis of peliosis lienis. Although the condition is often clinically silent, the forensic pathological significance arises from the differential diagnosis of resultant intraperitoneal haemorrhage and sudden death, mimicking a violent death.
Assuntos
Baço , Ruptura Esplênica , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura Esplênica/etiologia , Ruptura Esplênica/patologia , Baço/patologia , Baço/lesões , Patologia Legal , Hemoperitônio/etiologia , Hemoperitônio/patologia , Esplenomegalia/etiologia , Hemorragia/patologiaRESUMO
Atraumatic splenic rupture (AMR) is a life-threatening condition with a wide range of aetiologies, and it may present with a vague symptomatology. Therefore, AMR can be diagnostically challenging. In this review, we wish to focus on the fact that guidelines only exist for traumatic splenic rupture although they may be applicable for AMR too. In addition, a stringent ABCDE approach for clinical examination may early and reliable diagnose the patients and guide further imaging examination and treatment.
Assuntos
Ruptura Esplênica , Humanos , Exame Físico , Ruptura Espontânea/etiologia , Ruptura Esplênica/etiologiaRESUMO
ABSTRACT: Atraumatic splenic rupture is rare and not often considered in the differential diagnosis for patients with abdominal pain. This article describes a patient with atraumatic splenic rupture complicated by a congenital splenorenal anomalous shunt. The congenital anomaly increases patient risk and the degree of surgical difficulty, even if it is identified preoperatively.
Assuntos
Ruptura Esplênica , Humanos , Ruptura Esplênica/diagnóstico , Ruptura Esplênica/cirurgia , Esplenectomia , Dor Abdominal/diagnóstico , Diagnóstico Diferencial , Ruptura EspontâneaAssuntos
Pancreatite , Ruptura Esplênica , Humanos , Ruptura Esplênica/etiologia , Ruptura Esplênica/cirurgia , Ruptura Esplênica/diagnóstico por imagem , Pancreatite/etiologia , Pancreatite/cirurgia , Masculino , Pâncreas/lesões , Pâncreas/cirurgia , Pâncreas/diagnóstico por imagem , Baço/lesões , Baço/diagnóstico por imagem , Pessoa de Meia-Idade , Feminino , Risco , AdultoAssuntos
Infarto Cerebral , Poliarterite Nodosa , Ruptura Esplênica , Humanos , Poliarterite Nodosa/complicações , Poliarterite Nodosa/diagnóstico , Poliarterite Nodosa/patologia , Infarto Cerebral/etiologia , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/diagnóstico , Ruptura Esplênica/etiologia , Ruptura Esplênica/diagnóstico , Masculino , Feminino , Tomografia Computadorizada por Raios X , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Scrub typhus, an acute febrile disease with mild to severe, life-threatening manifestations, potentially presents with a variety of complications, including pneumonia, acute respiratory distress syndrome, cardiac arrhythmias (such as atrial fibrillation), myocarditis, shock, peptic ulcer, gastrointestinal bleeding, meningitis, encephalitis, and renal failure. Of the various complications associated with scrub typhus, splenic rupture has rarely been reported, and its mechanisms are unknown. This study reports a case of scrub typhus-related spontaneous splenic rupture and identifies possible mechanisms through the gross and histopathologic findings. CASE PRESENTATION: A 78-year-old man presented to our emergency room with a 5-day history of fever and skin rash. On physical examination, eschar was observed on the left upper abdominal quadrant. The abdomen was not tender, and there was no history of trauma. The Orientia tsutsugamushi antibody titer using the indirect immunofluorescent antibody test was 1:640. On Day 6 of hospitalization, he complained of sudden-onset left upper abdominal quadrant pain and showed mental changes. His vital signs were a blood pressure of 70/40 mmHg, a heart rate pf 140 beats per min, and a respiratory rate of 20 breaths per min, with a temperature of 36.8 °C. There were no signs of gastrointestinal bleeding, such as hematemesis, melena, or hematochezia. Grey Turner's sign was suspected during an abdominal examination. Portable ultrasonography showed retroperitoneal bleeding, so an emergency exploratory laparotomy was performed, leading to a diagnosis of hemoperitoneum due to splenic rupture and a splenectomy. The patient had been taking oral doxycycline (100 mg twice daily) for 6 days; after surgery, this was discontinued, and intravenous azithromycin (500 mg daily) was administered. No arrhythmia associated with azithromycin was observed. However, renal failure with hemodialysis, persistent hyperbilirubinemia, and multiorgan failure occurred. The patient did not recover and died on the fifty-sixth day of hospitalization. CONCLUSIONS: Clinicians should consider the possibility of splenic rupture in patients with scrub typhus who display sudden-onset abdominal pain and unstable vital signs. In addition, splenic capsular rupture and extra-capsular hemorrhage are thought to be caused by splenomegaly and capsular distention resulting from red blood cell congestion in the red pulp destroying the splenic sinus.
Assuntos
Insuficiência Renal , Tifo por Ácaros , Ruptura Esplênica , Masculino , Humanos , Idoso , Azitromicina , Tifo por Ácaros/complicações , Tifo por Ácaros/diagnóstico , Ruptura Esplênica/etiologia , Ruptura Esplênica/cirurgia , Hemorragia GastrointestinalRESUMO
Splenic rupture in a neonate is a rare but potentially fatal condition that may trigger evaluation for child abuse. It is a diagnosis of exclusion that has been reported in the surgical literature but may be underrecognized by pediatric radiologists. We report a case of a newborn with an unremarkable prenatal, delivery, and nursery course who presented with anemia, abdominal distension, and lethargy. Abdominal ultrasound with Doppler and computed tomography (CT) of the head, cervical spine, chest, abdomen, and pelvis without contrast showed findings of splenic rupture and anoxic brain injury. An extensive workup for traumatic, infectious, coagulopathic, and congenital etiologies was unrevealing, leading to a presumptive diagnosis of spontaneous splenic rupture in a neonate.
Assuntos
Ruptura Esplênica , Recém-Nascido , Criança , Humanos , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/cirurgia , Tomografia Computadorizada por Raios X/efeitos adversos , Ultrassonografia , Ruptura Espontânea/complicaçõesAssuntos
Traumatismo Múltiplo , Ruptura Esplênica , Traumatismos Torácicos , Ferimentos não Penetrantes , Humanos , Valva Tricúspide/cirurgia , Valva Tricúspide/lesões , Músculos Papilares/lesões , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Ruptura/etiologia , Ruptura/cirurgiaRESUMO
BACKGROUND: Infectious mononucleosis is common among adolescents and young adults. Although the majority of cases resolve spontaneously, life-threatening manifestations, and complications have been recognised. OBJECTIVE: The purpose of this article is to familiarize clinicians with the clinical manifestations, evaluation, diagnosis, and management of infectious mononucleosis. METHODS: A search was conducted in October 2022 in PubMed Clinical Queries using the key terms "infectious mononucleosis" OR "Epstein-Barr virus" OR "EBV". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the aforementioned search was used in the compilation of the present article. RESULTS: Infectious mononucleosis, caused by Epstein-Barr virus, most commonly affects adolescents and adults aged 15 to 24 years. Epstein-Barr virus is transmitted primarily in saliva. Infectious mononucleosis is characterized by a triad of fever, tonsillar pharyngitis, and lymphadenopathy. Fatigue may be profound but tends to resolve within three months. Periorbital and/or palpebral edema, typically bilateral, occurs in one-third of patients. Splenomegaly and hepatomegaly occur in approximately 50% and 10% of cases, respectively. A skin rash, which is usually widely scattered, erythematous, and maculopapular, occurs in approximately 10 to 45% of cases. Peripheral blood leukocytosis is observed in most patients; lymphocytes make up at least 50% of the white blood cell differential count. Atypical lymphocytes constitute more than 10% of the total lymphocyte count. The classic test for infectious mononucleosis is the demonstration of heterophile antibodies. The monospot test is the most widely used method to detect the serum heterophile antibodies of infectious mononucleosis. When confirmation of the diagnosis of infectious mononucleosis is required in patients with mononucleosis-like illness and a negative mono-spot test, serologic testing for antibodies to viral capsid antigens is recommended. Infectious mononucleosis is a risk factor for chronic fatigue syndrome. Spontaneous splenic rupture occurs in 0.1 to 0.5% of patients with infectious mononucleosis and is potentially life-threatening. Treatment is mainly supportive. Reduction of activity and bed rest as tolerated are recommended. Patients should be advised to avoid contact sports or strenuous exercise for 8 weeks or while splenomegaly is still present. Most patients have an uneventful recovery. CONCLUSION: Infectious mononucleosis is generally a benign and self-limited disease. Prompt diagnosis is essential to avoid unnecessary investigations and treatments and to minimize complications. Splenic rupture is the most feared complication. As avoiding exposure to EBV is almost impossible, the most effective way to prevent EBV infection and infectious mononucleosis is the development of an effective, safe, and affordable EBV vaccine that can confer life-long immunity.
Assuntos
Infecções por Vírus Epstein-Barr , Mononucleose Infecciosa , Ruptura Esplênica , Adolescente , Adulto Jovem , Humanos , Mononucleose Infecciosa/diagnóstico , Mononucleose Infecciosa/terapia , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/diagnóstico , Infecções por Vírus Epstein-Barr/terapia , Herpesvirus Humano 4 , Esplenomegalia/etiologia , Esplenomegalia/complicações , Anticorpos Heterófilos , Ruptura Esplênica/complicaçõesRESUMO
Little is known about iatrogenic splenic injury (SI) as an adverse event after colonoscopy. SI is sometimes fatal because of hemorrhaging. We herein report a man who developed SI after colonoscopy. He recovered conservatively. His history of left hydronephrosis and insertion with a maximally stiffened scope were suspected as possible risk factors. Endoscopists should consider the possibility of SI when they encounter patients suffering from left-sided abdominal pain after colonoscopy. Careful interview concerning the medical history and gentle maneuvering around the splenic flexure can help avoid SI.
Assuntos
Ruptura Esplênica , Masculino , Humanos , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/etiologia , Esplenectomia/efeitos adversos , Hemorragia/etiologia , Colonoscopia/efeitos adversosRESUMO
A patient was admitted to hospital with splenic rupture, four 4 days after colonoscopy was performed following one month's intermittent and aggravating abdominal pain. During recovery from splenectomy, the patient developed sudden tachycardic and tachypnoea. A blood sample revealed a very low blood glucose, high lactate and acidaemia.The patient required high-dose continuous intravenous glucose, while the lactate remained elevated. Decreasing consciousness with signs of acute liver failure necessitated transfer to an advanced intensive care unit. The patient's clinical status rapidly deteriorated despite therapeutic intervention. The patient died of multiorgan failure eleven days post-splenectomy. Based on the pathology of the spleen and a post-mortem liver specimen, the patient was diagnosed with a primary extra-nodal B-cell hepatosplenic lymphoma (BCHSL) - an extremely rare form of non-Hodgkin lymphomanon.Splenic rupture followed by lactic acidosis and hypoglycaemia should lead to suspicion of a cancer-mediated Warburg effect, and prompt urgent chemotherapy.
Assuntos
Acidose Láctica , Hipoglicemia , Falência Hepática Aguda , Linfoma não Hodgkin , Ruptura Esplênica , Humanos , Adulto , Acidose Láctica/etiologia , Ruptura Esplênica/etiologia , Ruptura Esplênica/cirurgia , Hipoglicemia/etiologia , Ácido Láctico , Ruptura EspontâneaRESUMO
Atraumatic splenic rupture (ASR) is a rare but life-threatening condition. Several underlying pathologies have been associated with a splenic rupture in the absence of trauma, most often malignant-haematological disorders, viral infections or local inflammatory disorders. The management of ASR is similar to traumatic splenic rupture and includes early risk stratification of patients to determine those eligible for non-operative treatment versus those who need immediate surgical intervention. In this report, we discuss a rare case of a non-operatively managed ASR in an otherwise healthy young patient with SARS-CoV-2 as the likely aetiology. The multisystemic nature of the ongoing novel COVID-19 is evident, but not all manifestations are yet known. This case report underlines the challenge for physicians in terms of recognising and treating emergent complications of this new disease.