RESUMO
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.
Assuntos
Colonoscopia/normas , Ruptura Esplênica/diagnóstico , Colonoscopia/métodos , Hemoperitônio/diagnóstico , Hemoperitônio/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Baço/lesões , Baço/cirurgia , Esplenectomia/métodos , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/fisiopatologia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia/métodosRESUMO
Spontaneous splenic rupture (SSR) is a rare condition in contrast to traumatic splenic hematoma, and vascular abnormality has rarely mentioned as an etiology in SSR with patients who had chronic kidney disease. We reported a 80-year-old female whose SSR might be related to splenic arterial calcification.
Assuntos
Falência Renal Crônica/fisiopatologia , Baço/lesões , Artéria Esplênica/fisiopatologia , Ruptura Esplênica/etiologia , Calcificação Vascular/complicações , Idoso de 80 Anos ou mais , Cálcio/metabolismo , Feminino , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/patologia , Falência Renal Crônica/terapia , Diálise Renal , Baço/irrigação sanguínea , Baço/cirurgia , Artéria Esplênica/metabolismo , Artéria Esplênica/cirurgia , Ruptura Esplênica/patologia , Ruptura Esplênica/fisiopatologia , Ruptura Esplênica/cirurgia , Calcificação Vascular/patologia , Calcificação Vascular/fisiopatologia , Calcificação Vascular/cirurgiaRESUMO
We present a case of a pregnant woman in the third trimester who came to the Department of Emergency, Sf. Apostol Andrei Emergency County Hospital, Constanta, Romania, in September 2016, for abdominal pain and ascites. After admission, the patient was periodically tested (biochemically and by ultrasound). We also payed attention to the fetal well-being. During the hospitalization, the patient was also found positive for syphilis. Biochemical values have progressively altered, the fetus started to present acute fetal distress and the patient gave birth by Caesarean section after two days of hospitalization. The intraoperatory surprise was hemoperitoneum caused by posttraumatic splenic rupture. The relevance of this case consists in its rarity (we were not able to find in the literature a case with the association of pregnancy, syphilis, trauma, and splenic rupture), in the difficult histopathological clear assertion and in the clinical awareness of such a condition.
Assuntos
Traumatismos Abdominais/complicações , Ruptura Esplênica/complicações , Ruptura Esplênica/etiologia , Adulto , Feminino , Humanos , Gravidez , Ruptura Esplênica/fisiopatologia , SífilisRESUMO
Spontaneous splenic rupture (SSR) is a rare but potentially life-threatening entity. It can be due to neoplastic, infectious, haematological, inflammatory and metabolic causes. An iatrogenic or an idiopathic aetiology should also be considered. Depending on the degree of splenic injury and the haemodynamic status of the patient, it can be managed conservatively. A 61-year-old man presented to the emergency department with an acute abdomen, hypovolaemic shock and clotting abnormalities. However, his focused assessment with sonography for trauma showed no evidence of an aortic aneurysm, rupture or dissection. Further investigation with a CT angiogram aorta confirmed a subcapsular splenic haematoma with free fluid in the pelvis and a mass in the superior pole of the spleen. He was diagnosed with an SSR. He was initially managed non-operatively. However, his repeat CT showed an enlarging haematoma and he underwent embolisation of his splenic artery. Ultrasound-guided core biopsy of his splenic mass confirmed the diagnosis of diffuse large B-cell lymphoma. This paper will discuss the clinical presentation, differential diagnosis and management of SSR. Furthermore, it provides an important clinical lesson to maintain a high index of clinical suspicion for splenic injury in patients presenting with left upper quadrant abdominal pain radiating to the shoulder. This case also reinforces the importance of close observation and monitoring of those individuals treated conservatively for signs of clinical deterioration.
Assuntos
Abdome Agudo , Linfoma Difuso de Grandes Células B , Baço , Neoplasias Esplênicas , Ruptura Esplênica , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Testes de Coagulação Sanguínea/métodos , Angiografia por Tomografia Computadorizada/métodos , Diagnóstico Diferencial , Humanos , Biópsia Guiada por Imagem/métodos , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/terapia , Masculino , Pessoa de Meia-Idade , Administração dos Cuidados ao Paciente/métodos , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/etiologia , Ruptura Espontânea/fisiopatologia , Ruptura Espontânea/terapia , Choque/diagnóstico , Choque/etiologia , Baço/diagnóstico por imagem , Baço/patologia , Baço/cirurgia , Neoplasias Esplênicas/complicações , Neoplasias Esplênicas/patologia , Neoplasias Esplênicas/terapia , Ruptura Esplênica/diagnóstico , Ruptura Esplênica/etiologia , Ruptura Esplênica/fisiopatologia , Ruptura Esplênica/terapia , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia de Intervenção/métodosRESUMO
During colonoscopy, the risk of injuring the spleen or other viscera except the colon is negligible. We report here a patient in whom spleen rupture did complicate the very early course of colonoscopy, but this remains an extremely rare complication with no more than 50 cases so far described. Diagnosis may be difficult, and the risk of spleen rupture seems to be greatest within 24 hours of colonoscopy. Mechanisms leading to spleen injury in the setting of colonoscopy are unclear; however, direct trauma, colon distension by insufflated air, and the excessive traction on the splenocolic ligament may be involved. Patients with splenomegaly and those with preexisting adhesions are at greater risk for this complication. Patients complaining of persistent abdominal pain after colonoscopy should be closely monitored and aggressively investigated for the suspect of spleen injury and rupture.
Assuntos
Colonoscopia/efeitos adversos , Ruptura Esplênica/etiologia , Idoso , Humanos , Masculino , Ruptura Esplênica/fisiopatologia , Ruptura Esplênica/cirurgiaRESUMO
BACKGROUND: Non-traumatic rupture of the spleen is a rare condition. It can occur in a pathological spleen caused by any of a variety of diseases. For yet unknown reasons this condition may sometimes involve an apparently normal spleen as well. OBJECTIVES: To examine the incidence, symptoms, causes, therapy and prognosis of "spontaneous" splenic rupture. METHODS: We conducted a retrospective study of seven patients diagnosed with splenic rupture not related to any traumatic event, who had been treated in the surgical department of a community hospital within the last 19 years. RESULTS: The male to female ratio was 5:2. In some patients, no background disease that could explain increased friability of splenic tissue could be identified. In some cases, where hemodynamic stability and absence of peritoneal signs afforded observation, splenectomy was delayed. In one case it was avoided altogether. CONCLUSIONS: "Spontaneous" rupture of spleen should be suspected when abdominal symptomatology occurs against a background of an acute infectious disease, especially in young males, or a disease known to affect target organs of the reticular endothelial system. Preoperative use of imaging studies in hemodynamically stable patients can sometimes obviate surgery, or in cases of massive hemoperitoneum reduce intraoperative time.
Assuntos
Hemoperitônio , Esplenectomia , Ruptura Esplênica/diagnóstico , Adolescente , Adulto , Feminino , Humanos , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Estudos Retrospectivos , Ruptura Espontânea , Ruptura Esplênica/etiologia , Ruptura Esplênica/fisiopatologiaRESUMO
Spontaneous rupture of malarial spleen is uncommon even in highly endemic areas of malaria. We report an eight year old girl who presented with spontaneous splenic rupture following malaria. She recovered with conservative management.
Assuntos
Malária/complicações , Ruptura Esplênica/etiologia , Criança , Feminino , Humanos , Malária/fisiopatologia , Fatores de Risco , Ruptura Espontânea/etiologia , Ruptura Espontânea/fisiopatologia , Ruptura Esplênica/fisiopatologia , Fatores de TempoRESUMO
We present the case of a 77-year-old woman who had an accidental fall in her garden, resulting in a fracture of her left ankle. After manipulation of the fracture, she developed sudden onset shortness of breath. An echo led to the diagnosis of Takotsubo cardiomyopathy. Shortly after this she developed sudden onset receptive and expressive dysphasia. Magnetic resonance imaging (MRI) of the head confirmed a left parietal infarct thought to be secondary to left ventricular thrombus formation. She was started on dabigatran. A few days later, she developed abdominal pain, and was subsequently diagnosed with a spontaneous splenic rupture. This case was interesting due to the unusual chain of events following a simple fall, and also a rare complication of anticoagulant therapy.
Assuntos
Anticoagulantes/efeitos adversos , Dabigatrana/efeitos adversos , Ruptura Esplênica , Cardiomiopatia de Takotsubo , Acidentes por Quedas , Doença Aguda , Idoso , Fraturas do Tornozelo , Anticoagulantes/uso terapêutico , Dabigatrana/uso terapêutico , Feminino , Cabeça/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Edema Pulmonar/diagnóstico , Edema Pulmonar/etiologia , Radiografia Abdominal , Ruptura Esplênica/induzido quimicamente , Ruptura Esplênica/diagnóstico , Ruptura Esplênica/fisiopatologia , Cardiomiopatia de Takotsubo/sangue , Cardiomiopatia de Takotsubo/complicações , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/tratamento farmacológico , Troponina/sangueRESUMO
Phaeohyphomycosis consists of a group of mycotic infections characterized by the presence of dematiaceous (dark walled) septate hyphae. Splenic abscess and spontaneous rupture is an infrequent complication in children with haematological malignancies and can be life threatening. To the best of our knowledge this is the first report of a case of splenic rupture following the development of multiple abscesses secondary to infestation by this rare fungal species.
Assuntos
Abscesso/patologia , Fungos/patogenicidade , Ruptura Espontânea , Ruptura Esplênica/fisiopatologia , Pré-Escolar , Feminino , Humanos , Malásia , Ruptura Espontânea/etiologia , Ruptura Esplênica/etiologiaRESUMO
A 63-year-old man who had had a history of rheumatoid arthritis presented with shock and hemoperitoneum, without a history of trauma. An emergency laparatomy revealed hemoperitoneum and splenic rupture with massive bleeding. Splenectomy was performed. Histopathological examination of the spleen revealed amyloid deposition in the wall of the vessels. Rectal biopsy revealed amyloid deposition in mucosa that indicating amyloidosis was systemic. Histochemical studies showed that amyloid was secondary or AA.
Assuntos
Amiloidose/fisiopatologia , Artrite Reumatoide/fisiopatologia , Ruptura Esplênica/fisiopatologia , Amiloidose/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura Espontânea/patologia , Ruptura Espontânea/fisiopatologia , Ruptura Esplênica/patologiaAssuntos
Hematopoese Extramedular , Baço/fisiopatologia , Ruptura Esplênica/fisiopatologia , Trombocitopenia/fisiopatologia , Adulto , Humanos , Masculino , Baço/cirurgia , Esplenectomia , Ruptura Esplênica/complicações , Ruptura Esplênica/cirurgia , Trombocitopenia/complicações , Trombocitopenia/congênitoRESUMO
BACKGROUND: To evaluate the clinical and laboratory characteristics of patients submitted to subtotal splenectomy during the immediate and late postoperative period. METHODS: The study was conducted on 34 patients, 25 of whom were submitted to subtotal splenectomy (group I), and 9 to total splenectomy without preservation of splenic tissue (group II), and on 22 patients with intact spleens (group III, control). The immediate and late postoperative complications were investigated. Hematological examinations were performed during the late postoperative period (red cell count, hemoglobin, platelets, total and segmented leukocytes, lymphocytes, and Howell-Jolly bodies). Immunoglobulins (IgA, IgM, and IgG) and total T lymphocytes (TTL), active T lymphocytes (ATL), and B lymphocytes were also determined. Splenic scintigraphy with (99m)Tc colloidal sulfur was performed. RESULTS: Groups I and III did not presented abnormal blood bodies and their hematological and immunological pattern were normal. None of the groups showed leukocytosis or thrombocytosis. Howell-Jolly bodies were observed only in group II, which also showed reduced IgM levels. Scintigraphy showed filtering splenic tissue in group I. CONCLUSIONS: We conclude that subtotal splenectomy is a good surgical alternative for serious distal spleen lesion or when the main splenic pedicle is injured.
Assuntos
Baço/lesões , Baço/fisiopatologia , Baço/cirurgia , Esplenectomia/métodos , Adolescente , Adulto , Contagem de Células Sanguíneas , Proteínas Sanguíneas/análise , Criança , Pré-Escolar , Feminino , Humanos , Imunoglobulinas/sangue , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Cintilografia , Compostos Radiofarmacêuticos , Baço/diagnóstico por imagem , Ruptura Esplênica/diagnóstico , Ruptura Esplênica/fisiopatologia , Ruptura Esplênica/cirurgia , Coloide de Enxofre Marcado com Tecnécio Tc 99m , Índices de Gravidade do Trauma , Resultado do TratamentoRESUMO
A case of traumatic splenic rupture in a hemodynamically stable elderly woman is presented. The patient decompensated almost immediately following the removal of a tight-fitting girdle. The implications of recognizing garments as potential counterpressure devices in emergency management are discussed. Emergency physicians are cautioned to carefully explore and reevaluate patients after the removal of tight-fitting garments.
Assuntos
Vestuário , Ruptura Esplênica/fisiopatologia , Ferimentos não Penetrantes/fisiopatologia , Idoso , Feminino , Humanos , Pressão , Ruptura Esplênica/etiologiaRESUMO
Spontaneous splenic rupture is a rare entity. It is usually associated with infectious, neoplastic, or hematologic diseases. Unlike traumatic splenic rupture, spontaneous rupture of the spleen is not often considered in the differential diagnosis of abdominal pain and can be easily confused with other abdominal pathology. Failure to consider splenic rupture can be catastrophic. We report a case of atraumatic splenic rupture in a patient with no underlying disease pathology. This illustrates the importance of keeping a broad differential in patients presenting with acute abdominal pain and should remind the physician to consider the diagnosis of spontaneous nontraumatic splenic rupture.
Assuntos
Dor Abdominal/diagnóstico , Ruptura Esplênica/diagnóstico , Dor Abdominal/etiologia , Doença Aguda , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Medicina Militar , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/fisiopatologia , Ruptura Esplênica/fisiopatologia , Fatores de TempoRESUMO
The authors report a series of 33 cases of documented splenic lesions which were not operated on. In their opinion non-surgical management is justified, thanks to the progress in ultrasonography and intensive care monitoring. They define out the modalities of this therapeutic choice.
Assuntos
Ruptura Esplênica/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Hospitalização , Humanos , Masculino , Monitorização Fisiológica , Ruptura Esplênica/fisiopatologia , Ruptura Esplênica/terapia , Fatores de TempoRESUMO
A 36 year-old woman with first degree splenic rupture from blunt abdominal trauma underwent laparotomy due to haemodynamic instability. The spleen was enlarged and difficult to mobilize with the rupture on the upper-lateral face of the spleen. Classic splenorrhaphy could not be performed. A single-clip-stapler made for laparoscopic herniotomy was used successfully to close the lesion.
Assuntos
Ruptura Esplênica/cirurgia , Grampeadores Cirúrgicos , Técnicas de Sutura/instrumentação , Adulto , Feminino , Humanos , Ruptura Esplênica/diagnóstico , Ruptura Esplênica/fisiopatologiaRESUMO
The authors have observed 2 new cases of splenic rupture due to pancreatic pseudocyst and have made a review of the literature on the subject (40 cases). The clinical, diagnostic and therapeutic approaches of this rare but sometimes dramatic complication of chronic pancreatitis have been analyzed. Diagnosis should be suspected in the case of abdominal pain, mass and anemia in the male subject with previously known chronic pancreatic or alcoholic disease. Sonography completed by either angiography or CT scan if time permits are the best diagnostic methods. Ideal management should include treatment (excision or drainage) of the pseudocyst and splenectomy.
Assuntos
Pancreatite/complicações , Ruptura Esplênica/etiologia , Adulto , Idoso , Doença Crônica , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatectomia , Pancreatite/diagnóstico , Pancreatite/fisiopatologia , Esplenectomia , Ruptura Esplênica/diagnóstico , Ruptura Esplênica/fisiopatologiaRESUMO
Investigations of changed viscosity, erythrocyte deformation and aggregation indices in patients on the traumatized spleen in the long term postoperative period were carried out in 85 patients. Spleenectomy was fulfilled in 35 patients, organ saving operations in 20 patients, and autolientransplantation in 30 patients. Spleenectomy was shown to cause increased viscosity, indices of deformation and aggregation of erythrocytes. To prevent the changes of the rheologic properties organ-saving operations and autolientransplantation should be widely used.
Assuntos
Baço/lesões , Baço/cirurgia , Esplenectomia/métodos , Ruptura Esplênica/sangue , Ruptura Esplênica/cirurgia , Adulto , Viscosidade Sanguínea/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Reologia/métodos , Ruptura Esplênica/fisiopatologiaRESUMO
OBJECTIVE: To investigate the indications for non-surgical management of traumatic splenic rupture. METHODS: From Jan. 2002 to Jan. 2008, 36 patients with traumatic splenic rupture underwent non-surgical management in the First Affiliated Hospital of Jinan University. RESULTS: Of the 36 cases, 32 were successfully managed without surgical interventions, and 4 converted to open surgery. No death occurred in these patients, nor was delayed splenic rupture identified 1 to 5 years after the treatment. CONCLUSION: Hemodynamically index is an important reference to select the patients, and the degree of splenic rupture, the patient's age and conditions of the hospital should be considered.