Unusual solution to abdominal pain with contrast enhanced ultrasound.

Splenic infarction might be the symptom onset of an important underlying disease. The possibility of splenic infarction must be inserted into differential diagnosis in all those patients who have pain in the upper left quadrant and/or on the left flank. When faced with a case of splenic infarction in a patient who has flown or climbed to high altitudes, it is appropriate to consider the possibility of an haemoglobinopathy. The diagnosis is far from being obvious for emergency physicians. For these reasons, it is very important to proceed as a multidisciplinary team with appropriate diagnostic examinations. The European Guidelines for non-hepatic applications of contrast enhanced ultrasound suggest the usage of this tool for investigation of suspected ischaemic lesions of the spleen.

Massive splenic infarction in an adolescent with hemoglobin S-HPFH.

Hemoglobin sickle-hereditary persistence of fetal hemoglobin (S-HPFH) is a condition in which there is compound heterozygosity for the Hb S mutation and the HPFH deletion. These patients have no anemia, little evidence of hemolysis and generally have a benign clinical course compared to other types of sickle cell anemia. We describe a 19-year-old male with HbS-HPFH who had no history of anemia or vaso-occlusive crisis, who presented with a massive splenic infarct. We conclude that patients with HbS-HPFH can occasionally present with severe complications and require a high level of clinical suspicion for complications when presenting to the hospital.

Spontaneous splenic infarction associated with sumatriptan use.

Triptans are specific agonists of the serotonergic 5-HT(1B/1D) receptors that have increasingly been used in the treatment of migraine and cluster headaches. Though they are generally considered safe, there have been a few reports of myocardial infarction and stroke associated with triptan use. We report a patient who developed spontaneous splenic infarction after the use of sumatriptan for the treatment of migraine headache.

Acute abdomen due to wandering spleen infarction: a case report.

We report a rare clinical case of acute abdomen due to partial infarction of a wandering spleen in the pelvis in a 60-year-old woman. The patient was suffering from stabbing pain in the external lower quadrant of the abdomen, irradiating back to the lumbosacral area, together with an unremitting feverish state (38 degrees C), sickness and constipation. After carrying out serological examinations, which revealed an increase in CPK and leukocytosis, ultrasonography and CT examinations were performed, revealing a mass in the left iliac cavity, which in all probability was a wandering spleen with an abnormally long pedicle and a dyshomogeneous lower area bearing witness to a splenic infarction. The patient was therefore submitted to surgery consisting in splenectomy after lysis of the adherences, which were plainly inflammatory. A wandering spleen, especially when infarcted, is a very rare clinical condition that may be congenital or acquired. Its presence can be confirmed by serological, ultrasonographical and CT examinations and must be suspected when there is no clearly defined acute abdomen.

An evaluation of parental knowledge, attitude and practice in the early diagnosis of acute splenic sequestration in sickle cell disease

Sickle cell disease is a global health problem. It is an inherited blood disorder affecting the red blood cells. There are different types of sickle cell disease. Homozygous sickle cell (SS) disease, results when the infant inherits two abnormal sickle genes, one from each parent. In Jamaica SS disease affects approximately 1 in 300 births and some form of sickle cell disease, 1 in 150 births. Complications of sickle cell disease include acute splenic sequestration. The cause and triggers of acute splenic sequestration (ASS) are largely unknown. The spleen becomes acutely enlarged, trapping a proportion of the red cell mass and leading to acute anaemia, circulatory failure and sometimes death. Emergency blood transfusion is extremely important in the management of acute splenic sequestration. Parental education may allow prevention of death from ASS by early transfusion. Parents need to be taught how to diagnose splenic enlargement, and to recognize the signs and symptoms of increasing anaemia characterized by pallor. It is important for mothers to examine splenic size on a regular basis and when the child looks ill. At the Jamaican Sickle Cell Unit, parents are instructed to examine the spleen at least once a day. The aim was to identify the parents' and guardians' knowledge of ASS, their attitudes towards the examination of the abdomen and practices in detecting an enlarging spleen. The objectives were to determine the percentage of parents and guardians who regularly examined the abdomen to determine spleen size; who had detected enlarging spleen and the outcome; who were aware of the proper technique for examining the spleen; who were aware of what to do if an enlarging spleen was found; and identify the barriers that prevent regular examination for splenic enlargement. The study was carried out on the parents and guardians of children four years and younger, with homozygous sickle cell disease, attending the sickle cell unit. At the time of the study, the population of children four years and younger with SS disease was 237. A questionnaire was designed based on the objectives of the study, to solicit data from the participants. The researcher administered the questionnaire to 60 parents and guardians who attended the clinic over a two-month period - March and April 2000. The participants were also asked to demonstrate their competences in examining the spleen...AU)

Splenic infarction in 16 dogs: a retrospective study.

Sixteen dogs with splenic infarction due to causes other than splenic torsion were identified. Dogs with splenic infarction often had multiple concurrent diseases, and surgical management of splenic infarction was associated with high mortality. Splenic infarction occurred in dogs with hypercoagulable conditions associated with liver disease, renal disease, and hyperadrenocorticism, or as a consequence of uniform splenomegaly, neoplasia, or thrombosis associated with cardiovascular disease. Clinical signs and common laboratory findings generally reflected the underlying disease process. A variety of splenic abnormalities were detected by abdominal ultrasound in 15 dogs, with the ventral extremity of the spleen being most often abnormal. Four dogs were euthanized or died because of the presence of severe systemic disease, whereas 12 dogs underwent laparotomy. Complete splenectomy was performed in 9 dogs and partial splenectomy was performed in 2 dogs. Seven dogs died in the immediate postoperative period, 3 required chronic veterinary care, and 2 had uncomplicated long-term recoveries. Splenic infaraction should be regarded as a sign of altered blood flow and coagulation, rather than as a primary disease, and surgical management should be reserved for patients with life-threatening complications such as hemoabdomen or sepsis.

Splenic function: normal, too much and too little.

This review is concerned with normal splenic function, mechanisms and consequences of splenomegaly, hypersplenism, the medical indications for splenectomy and the various aspects of hyposplenism. The potential probelm of lethal septicemia in hyposplenic or asplenic patients is also considered.