Atraumatic splenic rupture secondary to granulocyte-colony stimulating factor medication exposure.

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.

Atraumatic splenic rupture - unexpected consequences of a world trip.

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.

Spontaneous splenic rupture in a neonate: a case report and literature review.

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.

[Acute necrotizing pancreatitis with hemorrhagic shock in secondary splenic rupture: a case report and literature review]. / Akute nekrotisierende Pankreatitis mit hämorrhagischem Schock bei sekundärer Milzruptur: Ein Fallbericht und Literaturübersicht.

Atraumatic splenic rupture is a rare complication of acute and chronic pancreatitis. It arises due to its anatomical proximity to the pancreas, for instance, due to erosion of large pseudocysts or walled-of-necrosis (WON).Following we describe the case of a 62-year-old woman who presented for further diagnostics and treatment of acute pancreatitis with the development of large walled-of necrosis (WON) in the pancreatic corpus and tail. During the course, the patient developed a hemorrhagic shock. An emergency computer tomography (CT) of the abdomen revealed a ruptured spleen with a large capsular hematoma with no evidence of active bleeding. In contrast to previous published case reports, our treatment was exclusively minimal-invasive: by radiological guided embolization of the splenic artery and by endosonographic guided implantation of a lumen apposing metal stent (LAMS). The splenic hematoma was spontaneously regressive without secondary drainage.

Splenic rupture after colonoscopy for colorectal cancer screening.

Colonoscopy is a frequently used procedure in our environment for the diagnosis, treatment and even prevention of colorectal cancer. Despite being a routine procedure, it is not exempt from possible complications. Bleeding and perforation are the main ones, with splenic rupture being extremely infrequent as well as one of the most serious complications derived from performing a colonoscopy. We present a patient with splenic rupture secondary to colorectal cancer screening colonoscopy who required urgent surgery for acute hemorrhagic shock.

Spontaneous splenic rupture during dengue fever.

Dengue fever is one of the most frequent arboviral diseases in the world. Dengue is known to cause myocarditis, hepatitis, and neurological illustrations but one of the established presentations is leakage of plasma resulting in circulatory failure. Spontaneous rupture of the spleen is one of the most infrequent but known outcome of dengue fever which has been reported from time to time in literature. We present, here, the case of a 50-year-old patient who developed this condition during dengue fever and was managed in our department successfully. This complication must be kept in mind while treating any case of dengue fever so that it can be avoided or if not then treated timely.

A case of infectious mononucleosis complicated with spontaneous atraumatic splenic rapture caused by Epstein-Barr virus infection.

Splenic rupture is the most serious complication of infectious mononucleosis (IM) caused by Epstein-Barr virus (EBV) infection, with a mortality rate of over 1 in 10. We reported a case of spontaneous atraumatic splenic rupture secondary to IM in a young man. The patient presented with abdominal pain caused by splenic rupture as the initial symptom. The diagnosis and treatment process went through a series of twists and turns, including the emergency department, general surgery department, and infection department. This case suggests that clinicians should consider the possibility of EBV infection in young patients with spleen rupture without obvious cause to avoid misdiagnosis and missed diagnosis.

Atraumatic splenic rupture in a child with COVID 19.

BACKGROUND: The majority of children with COVID-19 have only minor symptoms or none at all. COVID-19, on the other hand, can cause serious illness in some children, necessitating hospitalization, intensive care, and invasive ventilation. Many studies have revealed that SARS-CoV-2 affects not only the respiratory system, but also other vital organs in the body. We report here a child with an atraumatic splenic rupture as the initial and only manifestation of COVID-19. CASE PRESENTATION: A 13-year-old boy with clinical signs of acute abdomen, left-sided abdominal pain, and hemodynamic instability was admitted to the PICU in critical condition. His parents denied any trauma had occurred. In addition to imaging tests, a nasopharyngeal swab was taken for COVID-19 testing, which was positive. The thoracic CT scan was normal, whereas the abdominal CT scan revealed hemoperitoneum, splenic rupture, and free fluid in the abdomen. CONCLUSIONS: The spleen is one of the organs targeted by the SARS-CoV-2. Splenic rupture, a potentially fatal and uncommon complication of COVID-19, can be the first and only clinical manifestation of the disease in children. All pediatricians should be aware of the possibility of atraumatic splenic rupture in children with COVID-19.

Rare cause of spontaneous spleen bleeding: a case report and literature review.

Rupture of the spleen is a serious medical condition manifesting as a sudden abdominal event, potentially life-threatening. Spontaneous spleen rupture is a rare condition. Atraumatic rupture of the spleen is a very unlikely condition. Risk factors include splenomegaly, hemato-oncological diseases, and infections, such as malaria or infectious mononucleosis. Extremely rare is splenic rupture described in autoimmune disease or vasculitis. There has been no reported case of spontaneous splenic rupture as a first manifestation of Churg- Strauss syndrome so far.

Splenic Artery Embolization after Delayed Splenic Rupture Following Blunt Trauma: Is Nonoperative Management Still an Option in This Cohort?

Patients treated with splenic artery embolization (SAE) >48 hours after a blunt injury for a delayed splenic rupture (DSR) were assessed for the need for a subsequent splenectomy. Thirty-four patients underwent SAE for DSR over 10 years at our level 1 trauma center, performed at a median of 4.5 days after the injury (interquartile range = 5.5), and the patients were followed up for a median of 11 months (interquartile range = 31). There were 3 occurrences of rebleeds, and 2 patients required splenectomy (5.9%). This study showed that treatment with SAE after DSR results in splenic salvage in 94.1% of patients.

Hemorrhagic shock caused by primary splenic pregnancy with spontaneous splenic rupture.

The subject, splenic pregnancy, is very rare and interesting with about a few cases reported to date. This case report describes a healthy 17-year-old girl admitted to our hospital who complained of amenorrhea for 30 days, intermittent abdominal pain for 3 days and worsening for 1 h. The serum human chorionic gonadotropin (hCG) was greater than 10000.0 IU/L. Pelvic ultrasonography showed a adnexal mass and empty uterine cavity. Due to consideration of "ectopic pregnancy," emergency laparoscopic surgery was performed. However, no clear lesions and bleeding points were detected during the operation. On postoperative day 2, hemoglobin level dropped sharply, meanwhile serum hCG increased significantly. Subsequent ultrasound showed a 4.4 × 4.1 × 2.6 cm gestational sac-like echo below the spleen. Laparotomy detected pregnancy tissues measured 4.0 × 3.5 cm next to the splenic hilum. Finally, the splenectomy was performed. Our case suggests that early diagnosis of splenic pregnancy is very difficult, especially when other conditions are combined. Despite this, we should still enrich ourself medical knowledge and clinical experience, and try to avoid the occurrence of splenic rupture.

Be careful of splenic rupture caused by hit by a pitch during a baseball game: a case report.

BACKGROUND: To the best of our knowledge, splenic rupture caused by hit by a pitch (HBP) has not been previously reported. We present a patient who underwent emergency laparotomy for splenic rupture after being HBP during a baseball game. CASE PRESENTATION: A 41-year-old male was HBP in the left abdomen during his first at-bat during a baseball game. During the operation, vascular injury of the splenic hilum and a deeply extending parenchymal injury were observed, and splenectomy was performed. Histologic findings were consistent with splenic rupture. CONCLUSIONS: The patient's postoperative course was uneventful. Although extremely rare, the possibility of intra-abdominal organ injury should be considered in batters who are hit in the abdomen by a pitched baseball, as illustrated by our patient.

Hemoperitoneum due to splenic injury after colonoscopy-Perhaps not a so uncommon a complication.

We have read with interest in your journal the article "Splenic rupture as an endoscopic complication: as rare as it appears?" and we would like to contribute a case handled in our hospital. We present the case of a 72-year-old male smokerto whom an elective colonoscopy was performed with conscious sedation (midazolam and pethidine). The bowel preparation was appropriate. Diverticula and several pedunculated polyps were observed.

Splenic rupture as an endoscopic complication: as rare as it appears?

The case was an 86-year-old male with multiple cardiovascular comorbidites, including anticoagulated atrial fibrillation, who underwent a colonoscopy due to acute lower gastrointestinal bleeding and anemia. Colonoscopy only showed some small angiodysplasias in the cecum. A few hours later, the patient presented with abdominal pain and hemodynamic instability. An abdominal computed tomography was performed, which showed a splenic laceration and hemoperitoneum. An expectant attitude was decided, with a good evolution from the abdominal point of view. There was no sign of active splenic bleeding in a control computed tomography. However, he developed decompensated heart failure and finally died.

Systematic review of spontaneous splenic rupture in dengue-infected patients.

Dengue infection varies from a mild febrile form to more severe disease with plasma leakage, shock, and multiorgan failure. Several serious complications such as cardiomyopathy, encephalopathy, encephalitis, hepatic damage, and neural manifestations cause organ damage in dengue infection. Splenic rupture, a less well known but life-threatening complication, can occur in dengue. The mechanism of splenic rupture in dengue is still unclear. Optimal therapeutic management is required to save the lives of patients with this complication. The objective of this study was to conduct a systematic review of studies documenting the development of spontaneous nontraumatic splenic rupture in patients with dengue infection. In March 2018, a search was conducted systematically in nine electronic databases, in addition to hand- searching. A total of 127 references were exported to Endnote; 47 references remained after removing duplicates. Finally, 16 reports met the inclusion criteria and represented 17 cases. All articles were evaluated and data extracted according to predefined criteria: number of cases, age, sex, severity of dengue disease, days of illness before admission, methods of definitive diagnosis, timing of the event, and management and outcome. A total of 17 individual patients including 13 males and four females were found. Most of the patients were young adults (ranging from 20 to 52 years) and diagnosed with computed tomography scan and managed with splenectomy. Four cases were fatal. Pathological splenic rupture in dengue is a rare, life-threatening condition where timely management can achieve a favorable outcome.

Spontaneous splenic hemorrhage in a patient on apixiban.

Novel oral anticoagulants (NOACs) are increasingly popular. Spontaneous splenic rupture is rare and life-threatening, especially if it is not immediately recognized. Prior work has demonstrated an association with NOAC use and spontaneous splenic rupture in unusual clinical circumstances. We present the case of spontaneous splenic hemorrhage in a largely healthy 57-year old female who was recently started on apixiban for a provoked PE. She had been discharged from an outside facility, and presented just hours after discharge to our emergency department in extremis: unconscious, pale, hypotensive, and tachycardic. Her abdomen on arrival was noted to be distended with positive fluid wave, and bedside ultrasound confirmed massive peritoneal fluid. Prompt diagnostic peritoneal aspirate confirmed hemoperitoneum, and a massive transfusion protocol was initiated. The patient's blood pressure and heart rate improved, and she was stabilized for imaging. Computed tomography demonstrated large subcapsular splenic hematoma with active extravasation at the periphery of the spleen. The patient was taken emergently to interventional radiology suite where splenic artery embolization was performed and an IVC filter was placed. She subsequently developed acute respiratory distress syndrome and persistent low urine output with hypotension despite resuscitation, and was taken to the operating room for splenectomy and abdominal washout. She improved thereafter and was discharged 12 days later. Prompt diagnosis and aggressive early resuscitation contributed to this patient's outcome.

Spontaneous splenic rupture following mitral valve replacement for infective endocarditis successfully managed with splenic artery embolisation.

We report a rare case of infective endocarditis complicated by postoperative splenic rupture. A patient underwent urgent mitral valve replacement for infective endocarditis believed to be associated with a recent spinal surgical intervention. The patient developed haemodynamic compromise on the third day postoperatively. Computed tomography showed a splenic rupture as the cause. The patient underwent emergency radiological intervention with coil embolization avoiding the need for a splenectomy and was discharged home.

Blunt abdominal injury resulting in a belly full of candy after a motocross accident, a case report.

BACKGROUND: Blunt traumatic gastric perforations in children are rare. Delayed diagnosis will lead to abdominal contamination and may result in morbidity and even mortality. We present a case of an adolescent who sustained blunt abdominal injury in a motocross accident and presented with remarkable hyperdense spherical shaped structures on the computed tomography (CT). CASE PRESENTATION: A 15-year-old boy arrived at the emergency room with an acute abdomen after a motocross accident. A CT scan of the abdomen demonstrated free air and hyperdense round structures in the stomach, pelvic cavity and right paracolic gutter. During emergency laparotomy a traumatic gastric perforation was sutured, a splenic rupture was treated with a vicryl mesh and multiple spherical food scraps were removed from the abdomen. After surgery, the boy clarified that he had eaten a whole bag of colorful and spherical shaped candy just before the accident. CONCLUSIONS: Traumatic gastric rupture in children is rare but physicians should be aware of this diagnosis in case of blunt abdominal trauma with free air on the CT scan. Gastric contents, in this case candy, can present as hyperdense shaped structures in the abdominal cavity on the CT scan.

Accessory Spleen Fracture: Report of a Pediatric Case and Review of the Literature.

Accessory spleen rupture may occur after blunt abdominal trauma or, more rarely, spontaneously. Although only few cases are described in adults, it is even more uncommon in children. We report the case of a 13-year-old boy with traumatic accessory spleen fracture. After a review of the literature, we discuss the diagnostic points that should raise the suspicion for accessory spleen fracture as well as how challenging the diagnosis by computed tomography can be.

A Case of Splenic Laceration Presenting as a Delayed Complication of Colonoscopy.

BACKGROUND: Colonoscopy is a frequently performed medical procedure; complications associated with this procedure often present to the emergency department (ED). Splenic laceration is a rare but life-threatening complication of colonoscopy. We report the unique case of a patient with a splenic laceration who presented after a recent colonoscopy and had no history of trauma. CASE REPORT: A 52-year-old man presented to our ED with abdominal pain and lightheadedness the day after a routine colonoscopy. Ultrasound demonstrated hemoperitoneum, and contrast-enhanced computed tomography of the abdomen revealed a large hemoperitoneum with active contrast extravasation from the laceration of the superior pole of the spleen. After resuscitation, the patient was managed with an emergency splenectomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Colonoscopy complications are frequently identified and managed in the ED. Splenic laceration should be on the differential for patients that present with abdominal pain or hypotension after colonoscopy. Splenic injury carries a high mortality risk, and prompt, accurate diagnosis can be lifesaving.