RESUMEN
Typhoid fever is caused by Salmonella species. The most common hematological complications described are anemia and disseminated intravascular coagulation. Splenic infarction is an unusual complication of typhoid fever, and this presentation is rarely described. We report the case of a young female who presented with complaints of severe left upper quadrant pain after being diagnosed with typhoid fever. Computed tomography (CT) revealed multiple wedge-shaped splenic infarcts. She was treated with antibiotics and was also started on antiplatelets. She had a complete recovery with this management, and antiplatelets were tapered off on subsequent visits.
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Antibacterianos , Infarto del Bazo , Tomografía Computarizada por Rayos X , Fiebre Tifoidea , Humanos , Fiebre Tifoidea/complicaciones , Fiebre Tifoidea/diagnóstico , Fiebre Tifoidea/tratamiento farmacológico , Femenino , Antibacterianos/uso terapéutico , Infarto del Bazo/etiología , Infarto del Bazo/diagnóstico , AdultoRESUMEN
BACKGROUND: Plasmodium ovale malaria is usually considered a tropical infectious disease associated with low morbidity and mortality. However, severe disease and death have previously been reported. CASE PRESENTATION: A case of severe P. ovale malaria in a healthy Caucasian man with a triangle splenic infarction and clinical progression towards Acute Respiratory Distress Syndrome was reported despite a rapid response to oral chloroquine treatment with 24-h parasitaemia clearance. CONCLUSION: Plasmodium ovale malaria is generally considered as a benign disease, with low parasitaemia. However, severe disease and death have occasionally been reported. It is important to be aware that occasionally it can progress to serious illness and death even in immunocompetent individuals.
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Antimaláricos , Malaria , Plasmodium ovale , Síndrome de Dificultad Respiratoria , Infarto del Bazo , Masculino , Humanos , Antimaláricos/uso terapéutico , Infarto del Bazo/diagnóstico , Infarto del Bazo/complicaciones , Infarto del Bazo/tratamiento farmacológico , Malaria/complicaciones , Malaria/diagnóstico , Malaria/tratamiento farmacológico , Síndrome de Dificultad Respiratoria/diagnóstico , Síndrome de Dificultad Respiratoria/etiología , ItaliaRESUMEN
INTRODUCTION: Splenic infarction is a rare event in clinical practice, diagnosed by CT scan. There are many causes. They often determine the treatment given. However, there is no consensus on etiological investigations. METHODS: We present here an almost systematic review of the literature, based on data available on Pubmed from 1991 to 2022. Using the keywords "splenic infarct", from 1893 references, 11 cohort studies and 867 clinical cases were included in this review. Articles written in languages using alphabets other than Latin were excluded. RESULTS AND CONCLUSIONS: Analysis of these various studies has enabled us to draw up a list that is intended to be as exhaustive as possible of the causes of splenic infarction. The most frequent are emboligenic heart disease, hematological malignancies, solid neoplasia and certain infections. The descriptions available in the literature were mainly based on isolated clinical cases, not always making it possible to establish a causal link with the disease described, especially as around 20% of reported cases of splenic infarction were asymptomatic and potentially of incidental discovery. Based on the findings of this literature review, we propose a protocol for the etiological assessment of splenic infarcts.
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Infarto del Bazo , Humanos , Infarto del Bazo/diagnóstico , Infarto del Bazo/etiología , Neoplasias/complicacionesRESUMEN
BACKGROUND: Sickle cell trait (SCT), the heterozygous form of sickle cell disease, is generally thought of as a benign condition. However, it is possible for those with SCT to have serious complications, especially when they are exposed to high altitudes where oxygen levels are low. CASE REPORT: We present a case of a 41-year-old man with a history of SCT who developed severe epigastric pain and nearly lost consciousness while traveling on a commercial airplane. His twin brother, who also has SCT, had a similar episode in the past and required a splenectomy. A splenic subcapsular hematoma was found in a computed tomography scan of the abdomen and pelvis with intravenous contrast. He was admitted and managed conservatively until his symptoms resolved. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Though SCT is prevalent in our population, the complications that can arise, such as altitude-associated splenic syndrome, have likely not been thoroughly investigated. Physicians should add this condition to their differential if they practice at locations near airports or in areas of higher altitude and if their patients have a past medical history of SCT.
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Viaje en Avión , Rasgo Drepanocítico , Enfermedades del Bazo , Infarto del Bazo , Masculino , Humanos , Adulto , Altitud , Infarto del Bazo/complicaciones , Infarto del Bazo/diagnóstico , Enfermedades del Bazo/etiología , Rasgo Drepanocítico/complicaciones , Rasgo Drepanocítico/diagnóstico , Hematoma/complicacionesRESUMEN
Introducción: El infarto esplénico es una de las enfermedades que se presentan secundarias al fallo de aclimatación. En la literatura revisada se relaciona con la presencia de un rasgo sicklémico y desde la década del 50 se tienen reportes de casos a nivel mundial. Objetivo: Describir un caso de infarto esplénico por exposición a la altura. Presentación del caso: Se expuso un paciente que presentó un infarto esplénico después de su exposición a la altura, el cual fue intervenido quirúrgicamente y se presentaron un grupo de complicaciones en el posoperatorio. En la literatura internacional esta enfermedad se relaciona con la presencia de la hemoglobina S, lo cual no concuerda con nuestro paciente, a pesar de no ser el estudio de elección. Sus antecedentes pudieron contribuir a la ocurrencia de esta complicación. Las complicaciones que aparecieron en el posoperatorio coincidieron con las comentadas por otros autores. Conclusiones: El infarto esplénico por exposición a la altura es una complicación que debe tenerse en cuenta cuando se presenta un paciente a su llegada a este ecosistema, aparece con dolor abdominal, donde la inmediatez en la conducta es fundamental para evitar complicaciones de mayor gravedad(AU)
Introduction: Splenic infarction is one of the diseases that occur secondary to failure of acclimatization. In the reviewed literature, it is related to the presence of a sicklemic trait and since the 1950s there have been case reports worldwide. Objective: To describe a case of splenic infarction due to exposure to high altitude. Case report: We report the case of a patient who had a splenic infarct after exposure to high altitude. This patient, who underwent surgery, had a group of complications during the postoperative period. The international literature associates this disease with the presence of hemoglobin S, which does not coincide with the case of our patient, despite not being the study of choice. His history could have contributed to the occurrence of this complication. Those that appeared in the postoperative period did agree with those commented by other authors. Conclusions: Splenic infarction due to exposure to altitude is a complication that must be taken into account when a patient has abdominal pain. Immediacy in behavior is essential to avoid more serious complications(AU)
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Humanos , Masculino , Femenino , Infarto del Bazo/diagnóstico , AclimataciónRESUMEN
COVID-19 has been associated with the hypercoagulable state in the literature. Patients who are admitted to the hospital with severe COVID-19 may have some thrombotic complications. These patients have a high risk for venous and arterial thrombosis of large and small vessels. Here, a 42-year-old female with celiac artery thrombosis and splenic infarction after a history of mild COVID-19 was presented.
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COVID-19 , Infarto del Bazo , Trombofilia , Trombosis , Adulto , COVID-19/complicaciones , Arteria Celíaca/diagnóstico por imagen , Femenino , Humanos , Infarto del Bazo/diagnóstico , Infarto del Bazo/etiología , Trombofilia/complicaciones , Trombosis/complicaciones , Trombosis/etiologíaRESUMEN
Accessory spleens are common congenital anatomic variations that are usually asymptomatic. On the other hand, they can be clinically significant if complicated by hemorrhage, torsion, or infarction. This paper describes a case of an infarcted accessory spleen in a 30-year-old male who presented with abdominal pain. Abdominal CT and MRI revealed an isolated mass, 4.5 cm in size, in the perisplenic area. An infarcted accessory spleen was suspected. The patient underwent laparoscopic accessory splenectomy. Histopathology identified the mass as splenic tissue that had undergone ischemic necrosis. A definitive diagnosis of an infarcted accessory spleen was made, and the patient was discharged on day 5 after surgery symptom-free.
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Enfermedades del Bazo , Infarto del Bazo , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Adulto , Humanos , Masculino , Esplenectomía , Infarto del Bazo/diagnósticoRESUMEN
We report the case of a 70-year-old man who developed a splenic infarction due to a thrombus in the pulmonary vein (PV) stump after left upper lobectomy (LUL). Preoperative imaging showed a mass measuring > 5 cm in the upper lobe of the left lung, and sputum cytology revealed squamous cell carcinoma. Therefore, video-assisted thoracoscopic LUL was performed. The postoperative course was uneventful but biochemical blood tests showed an increased inflammatory response. Contrast-enhanced computed tomography revealed splenic infarction and a thrombus in the left superior PV stump. Prompt treatment with anticoagulants was administered, and the patient was discharged with mild recovery. However, the patient developed cerebral infarction after discharge and died 33 days after the surgery. Splenic infarction is a rare postoperative complication, with only three reported cases, including this report. However, this condition should be considered along with PV thrombus when evaluating an increased inflammatory response after LUL.
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Neumonectomía , Infarto del Bazo , Anciano , Humanos , Masculino , Neumonectomía/efectos adversos , Infarto del Bazo/diagnóstico , Infarto del Bazo/etiologíaRESUMEN
A wandering spleen is a very rare event characterised by the absence of the spleen in its anatomical position due to the hyperlaxity of its ligaments. We present a case of wandering spleen complicated by splenic vascular pedicle torsion, thrombosis and subsequent splenic infarction. Compression of the infarcted spleen on the rectosigmoid junction led to the development of a sigmoid volvulus, which presented as an acute large bowel obstruction. The patient underwent emergency laparotomy, splenectomy, sigmoid decompression and sigmoidopexy. After a follow-up period of two years, the volvulus had not recurred.
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Obstrucción Intestinal/etiología , Vólvulo Intestinal/etiología , Enfermedades del Sigmoide/etiología , Infarto del Bazo/diagnóstico , Ectopía del Bazo/diagnóstico , Enfermedad Aguda , Femenino , Humanos , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/cirugía , Vólvulo Intestinal/diagnóstico , Vólvulo Intestinal/cirugía , Persona de Mediana Edad , Enfermedades del Sigmoide/diagnóstico , Enfermedades del Sigmoide/cirugía , Esplenectomía , Infarto del Bazo/complicaciones , Infarto del Bazo/cirugía , Ectopía del Bazo/complicaciones , Ectopía del Bazo/cirugíaRESUMEN
A 55-year-old man treated with polycythemia vera visited our hospital, complaining of left abdominal pain and dyspnea. He had received minocycline infusions three weeks earlier for mycoplasma pneumonia. Contrast-enhanced computed tomography revealed pulmonary embolism and splenic infarction. Ultrasonography of the vein in the forearm revealed a thrombus filling the distal brachial veins to the radial veins on both sides. His condition improved after anticoagulant therapy, and right and left shunts were detected on transesophageal echocardiography. This suggested that thrombus in the forearm may have been the source of the embolism.
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Policitemia Vera , Embolia Pulmonar , Infarto del Bazo , Trombosis , Humanos , Masculino , Persona de Mediana Edad , Minociclina/efectos adversos , Policitemia Vera/complicaciones , Policitemia Vera/tratamiento farmacológico , Embolia Pulmonar/inducido químicamente , Embolia Pulmonar/diagnóstico por imagen , Infarto del Bazo/diagnóstico , Infarto del Bazo/diagnóstico por imagenAsunto(s)
Mononucleosis Infecciosa/diagnóstico , Infarto del Bazo/diagnóstico , Servicio de Urgencia en Hospital , Femenino , Humanos , Mononucleosis Infecciosa/complicaciones , Infarto del Bazo/diagnóstico por imagen , Infarto del Bazo/etiología , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
INTRODUCTION: Patients with sickle cell trait (SCT) are commonly considered as asymptomatic carriers. However, some clinical manifestations may occur. METHODS: Here we present a retrospective descriptive study about SCT subjects with at least one complication diagnosed in a sickle cell disease referral center, in Paris, between 2008 and 2019. We also performed a literature review on the complications of SCT subjects. RESULTS: Six patients (between 19 and 65 years old) were included. SCT was already known only for 4 of them at the time of the complication. Four patients presented with a splenic infarct after a stay in high altitude or a plane trip, one of them was associated with papillary necrosis; one patient had isolated papillary necrosis, and the last one had splenic sequestration. These complications happened for most of them after exposure to an unusual situation of hypoxia or deshydratation. Five out of 6 patients had a marked elevated C reactive protein. CONCLUSION: SCT may cause acute ischemic complications in a context of prolonged hypoxia or dehydration. The most commonly reported are the splenic infarct and the renal papillary necrosis. A study of hemoglobin should be considered in these clinical situations in patients with compatible ethnic origin.
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Necrosis Papilar Renal/diagnóstico , Rasgo Drepanocítico/complicaciones , Infarto del Bazo/diagnóstico , Adulto , Anciano , Anemia de Células Falciformes/complicaciones , Femenino , Humanos , Isquemia/diagnóstico , Isquemia/etiología , Necrosis Papilar Renal/etiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Rasgo Drepanocítico/diagnóstico , Rasgo Drepanocítico/patología , Infarto del Bazo/etiología , Adulto JovenAsunto(s)
Aneurisma de la Aorta/complicaciones , Disección Aórtica/complicaciones , Isquemia/complicaciones , Gastropatías , Estómago/irrigación sanguínea , Arteria Celíaca , Tratamiento Conservador , Desbridamiento , Gastroscopía , Humanos , Intubación Gastrointestinal , Isquemia/terapia , Masculino , Persona de Mediana Edad , Infarto del Bazo/diagnóstico , Infarto del Bazo/etiología , Infarto del Bazo/terapia , Estómago/cirugía , Gastropatías/etiología , Gastropatías/terapia , Tomografía Computarizada por Rayos XRESUMEN
Scrub typhus has a variety of clinical presentations ranging from asymptomatic to fever with chills, myalgias, hepatitis, gastric ulcerations and pancreatitis, all being attributed to disseminated vasculitis, with splenic infarction being a rare presentation. A 26-year man, a resident of north India, presented with an acute febrile illness and abdominal pain, computed tomography scan of the abdomen was suggestive of a splenic infarct. After ruling out other aetiology, a positive IgM (ELISA) for scrub typhus led to treatment with oral doxycycline, following which the patient was discharged symptom-free. Rarely can splenic infarction be attributable to scrub typhus; so far, five such cases have been reported in the published literature.
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Tifus por Ácaros/complicaciones , Infarto del Bazo/etiología , Adulto , Doxiciclina/uso terapéutico , Humanos , India , Masculino , Tifus por Ácaros/diagnóstico , Tifus por Ácaros/tratamiento farmacológico , Infarto del Bazo/diagnóstico , Infarto del Bazo/tratamiento farmacológico , Resultado del TratamientoRESUMEN
La gastrectomía vertical laparoscópica es actualmente la cirugía bariátrica más empleada a nivel mundial. Aunque es un procedimiento seguro y efectivo pueden ocurrir complicaciones mayores. En el presente trabajo reportamos el caso de un infarto y absceso esplénico como una rara complicación de esta técnica, que requirió finalmente de esplenectomía como tratamiento definitivo. Caso clínico: Mujer de 22 años con obesidad grado I, a quien se le practicó gastrectomía vertical laparoscópica con buena evolución intrahospitalaria y egreso a las 48 horas. Al 4to día posoperatorio consultó por fiebre, dolor abdominal, taquipnea y taquicardia. Mediante tomografía computada de abdomen se diagnosticó infarto esplénico parcial. Recibió tratamiento médico con remisión inicial de los síntomas, los cuales reaparecieron a la 3era semana. Se reinició el tratamiento médico, esta vez sin respuesta, y con evolución al absceso esplénico. Se decidió esplenectomía como tratamiento definitivo logrando la recuperación completa de la paciente. Conclusión: El infarto esplénico es una complicación infrecuente de la gastrectomía vertical. Su tratamiento inicial es médico, reservando la esplenectomía para los casos que no responden(AU)
Laparoscopic sleeve gastrectomy is currently the most performed bariatric surgery worldwide. Although it is an effective and safe procedure major complications can occur. In the present manuscript we report a case of splenic infarct and abscess as a rare complication of laparoscopic sleeve gastrectomy, finally requiring a splenectomy as a definitive treatment. Case report: A 22 years old woman with grade I obesity underwent laparoscopic sleeve gastrectomy with good hospital evolution and 48 hours discharge. On the 4th postoperative day she return because fever, abdominal pain, tachypnea and tachycardia. By means of a computed tomography a splenic infarct was diagnosed. She received medical treatment with initial remission of symptoms, which reappear at the third week. Medical treatment was restarted, this time without success, and with progression to splenic abscess. We decided a splenectomy as definitive treatment achieving a complete patient recovery. Conclusion: Splenic infarction is a rare complication after sleeve gastrectomy. The treatment is non surgical, reserving the splenectomy for the non responded cases(AU)
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Humanos , Femenino , Adulto , Adulto Joven , Infarto del Bazo/etiología , Laparoscopía/efectos adversos , Cirugía Bariátrica/efectos adversos , Gastrectomía/efectos adversos , Esplenectomía , Infarto del Bazo/cirugía , Infarto del Bazo/diagnóstico , Laparoscopía/métodos , Cirugía Bariátrica/métodos , Gastrectomía/métodos , Obesidad/cirugíaRESUMEN
Background: Sickle cell trait (SCT) is a common genetic abnormality in the so-called "sickle belts" in India. Splenic infarction often brings to medical attention an underlying SCT, when appropriately looked for. The hypoxic environment of an extreme high-altitude area (HAA) is conducive for developing a splenic infarct in an SCT individual not a native of these areas. Aims: We studied retrospectively 27 cases who presented with a splenic infarction during the last 4 years. Results: Twenty-five patients (92.5%) were diagnosed to have SCT, and 85% patients had developed splenic infarct on exposure to very HAAs. Clinically, splenomegaly was seen in 33% of patients with splenic infarct at presentation. The mean hemoglobin S was 36.92% in SCT individuals. A thrombus in the splenoportal axis was demonstrated in 22.2% of cases. Splenic rupture was a rare event, seen in only 3.5% of patients. Splenectomy was not required in any of the cases. Splenic abscess was not seen, and antibiotics were not required in any of the cases. We discuss the profile and management of these patients and review the literature on splenic infarction in HAA. Conclusion: SCT is commonly overlooked cause of splenic infarction and conservative management is effective in most of the cases. Splenectomy is required only in the rarest of rare cases. The profile and management of these patients and a review of the literature on splenic infarction in HAA has been discussed.
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Altitud , Hipoxia/complicaciones , Montañismo , Rasgo Drepanocítico/complicaciones , Infarto del Bazo/diagnóstico , Adulto , Anticoagulantes/uso terapéutico , Tratamiento Conservador , Humanos , Masculino , Estudios Retrospectivos , Infarto del Bazo/complicaciones , Infarto del Bazo/terapia , Rotura del Bazo/diagnóstico por imagen , Rotura del Bazo/etiología , Esplenomegalia/diagnóstico por imagen , Esplenomegalia/etiología , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler , Trombosis de la Vena/diagnóstico por imagen , Trombosis de la Vena/tratamiento farmacológico , Adulto JovenRESUMEN
El infarto esplénico es una entidad rara en la edad pediátrica que, cuando se encuentra, se asocia a otros factores predisponentes, como enfermedades oncológicas, hematológicas o infecciosas. Su presentación es asintomática o sintomática con dolor abdominal, fiebre y esplenomegalia. No existe consenso sobre cuál es la mejor opción de tratamiento, y se decide, en la mayoría de los casos, un manejo conservador o quirúrgico de acuerdo con las características individuales del paciente. Se presenta el caso de un paciente escolar que acude por un cuadro de dolor abdominal agudo y fiebre con diagnóstico de infarto esplénico masivo sin etiología aparente que fue manejado de manera conservadora, con evolución favorable. Es importante considerar este padecimiento como causa de dolor abdominal asociado a esplenomegalia y destacar la relevancia de esta presentación de caso, ya que se presenta sin relación con enfermedades subyacentes.
Splenic infarction is a rare entity in the paediatric age that, when found, is associated with other predisposing factors such as oncological, haematological or infectious diseases. It is whether asymptomatic or symptomatic with abdominal pain, fever and splenomegaly. There is no consensus on which is the best treatment option, in most cases deciding conservative or surgical management according to individual patient characteristics. We present the case of a patient with acute abdominal pain and fever with a diagnosis of massive splenic infarction without apparent aetiology that was managed conservatively with favourable evolution. It is important to consider this condition as a cause of abdominal pain associated with splenomegaly.
Asunto(s)
Humanos , Masculino , Niño , Infarto del Bazo/diagnóstico , Esplenomegalia , Pediatría , Infarto del Bazo/tratamiento farmacológico , Dolor Abdominal , FiebreRESUMEN
Splenic infarction is a rare entity in the paediatric age that, when found, is associated with other predisposing factors such as oncological, haematological or infectious diseases. It is whether asymptomatic or symptomatic with abdominal pain, fever and splenomegaly. There is no consensus on which is the best treatment option, in most cases deciding conservative or surgical management according to individual patient characteristics. We present the case of a patient with acute abdominal pain and fever with a diagnosis of massive splenic infarction without apparent aetiology that was managed conservatively with favourable evolution. It is important to consider this condition as a cause of abdominal pain associated with splenomegaly.
El infarto esplénico es una entidad rara en la edad pediátrica que, cuando se encuentra, se asocia a otros factores predisponentes, como enfermedades oncológicas, hematológicas o infecciosas. Su presentación es asintomática o sintomática con dolor abdominal, fiebre y esplenomegalia. No existe consenso sobre cuál es la mejor opción de tratamiento, y se decide, en la mayoría de los casos, un manejo conservador o quirúrgico de acuerdo con las características individuales del paciente. Se presenta el caso de un paciente escolar que acude por un cuadro de dolor abdominal agudo y fiebre con diagnóstico de infarto esplénico masivo sin etiología aparente que fue manejado de manera conservadora, con evolución favorable. Es importante considerar este padecimiento como causa de dolor abdominal asociado a esplenomegalia y destacar la relevancia de esta presentación de caso, ya que se presenta sin relación con enfermedades subyacentes.