Case Of Splenic Rupture Research Articles

Acute splenic pathology on CT in patients with babesiosis.

To better understand the occurrence of splenic disease as a potential manifestation of babesiosis by retrospectively estimating the frequency of acute splenic injury on abdominal and pelvic CT in a cohort of patients with active babesia infection. In a search of our single institution, suburban teaching community hospital database, 57 patients were found to have positive babesia infection between the years 2021-2023. 29 of these patients underwent abdominal and pelvic CT (22 with and 7 without intravenous contrast), and 3 underwent abdominal ultrasound without any CT. The imaging was reviewed for the presence or absence of splenic abnormalities, and for follow-up imaging. Parasitemia levels at the time of imaging were also reviewed; parasitemia levels < 4% are associated with mild to moderate disease, whereas parasitemia levels > 4% are associated with severe disease. 21/32 (66%) patients who underwent any type of abdominal imaging (ultrasound, MRI, and CT) had splenomegaly. Of the 22 patients who had IV contrast-enhanced CT scans, 6 were found to have splenic infarction (27%). One of these 22 patients had multiple rounded non-peripheral hypoenhancing foci on both CT and MRI which did not meet criteria for infarction, in association with splenomegaly, and which resolved after treatment. 0/6 patients in the splenic infarction group had parasitemia levels greater than 4%, while 4 of the 16 patients (4/16) without infarction had parasitemia levels of greater than 4%. Our study showed that splenic disease in patients with babesiosis mostly took the form of splenomegaly, and in a substantial minority of patients as splenic infarction. There were no cases of splenic rupture and perisplenic hematoma in our case series, likely reflecting a limitation of the relatively small study size. Concordant with prior studies, we found no identifiable association between parasitemia levels and the presence of splenic infarction.

Ultrasonographic findings of a rare case of splenic rupture and torsion in a dog

AbstractA 7‐year‐old dog presented with acute lethargy, anorexia and vomiting. Ultrasonographic examination revealed a hypoechoic mass lesion in the left abdomen, characterised by a hilum‐like structure and intraparenchymal gas. A mild amount of hyperechoic peritoneal effusion was present. An apparently normal spleen was visualised, which was not associated with the described mass lesion. Surgery revealed a presumed previously ruptured and separated spleen. The caudal portion of the spleen was acutely torsed and there was a mild amount of peritoneal fluid present. Histopathology confirmed splenic torsion of the previously ruptured and separated caudal splenic segment. Bacterial culture of the peritoneal effusion after enrichment indicated Staphylococcus aureus. The patient recovered successfully and maintained excellent clinical conditions at 14‐month follow‐up. Splenic torsion of a ruptured splenic segment should be considered as a differential diagnosis for an emphysematous mass containing a hilum‐like structure in the abdomen in dogs.

Splenic artery pathology presentation, operative interventions, and outcomes in 88 patients with vascular Ehlers-Danlos syndrome

ObjectiveVascular Ehlers-Danlos syndrome (VEDS) is rare and associated with arteriopathies. The aim of this study is to investigate the presentation, operative interventions, and outcomes of splenic arterial pathology in a population of more than 1500 individuals with genetically confirmed VEDS due to pathogenic COL3A1 variants. MethodsCross-sectional analysis of 1547 individuals was performed. The data were assembled by harmonizing data from three overlapping cohorts with genetically confirmed VEDS: the VEDS Collaborative Natural History Study (N = 242), a single-center cohort (N = 75), and the University of Washington Collagen Diagnostic Lab cohort (N = 1231). Duplicates were identified and removed. Patients were selected for analysis if they had splenic artery aneurysm (SAA), pseudoaneurysm, dissection, thrombosis, or rupture. Demographics, COL3A1 variants, interventions, and outcomes were analyzed. Comparisons by splenic artery rupture were made. ResultsA total of 88 patients presented between 1992 and 2021 with splenic artery pathology (5.7% of the cohort; mean age at diagnosis, 37 ± 11.1 years; 50% male). One-third were diagnosed with VEDS prior to the splenic artery pathology diagnosis, and 17% were diagnosed post-mortem. Most had a positive family history (61%). Most had COL3A1 variants associated with minimal normal collagen production (71.6%). Median follow up was 8.5 years (interquartile range, 0.9-14.7 years). Initial presentation was rupture in 47% of the cases. Splenic artery rupture overall was 51% (n = 45), including four cases of splenic rupture. There were no major differences in VEDS-related manifestations or COL3A1 variant type by rupture status. SAA was noted in 39% of the cases. Only 12 patients had splenic artery diameter documented in 12 cases with a median diameter of 12 mm (interquartile range, 10.3-19.3 mm). A total of 34 patients (38.6%) underwent 40 splenic arterial interventions: 21 open surgical, 18 embolization, and one unknown procedure. More than one splenic artery intervention was performed in five cases (14.7%). Open repair complications included arteriovenous fistula (n = 1), intestinal or pancreatic injury (n = 1 each), and four intraoperative deaths. There were no deaths or access site complications related to splenic artery embolization. Four patients (23.5%) developed a new SAA in the remaining splenic artery post embolization. All-cause mortality was 35% (n = 31), including 22 related to a ruptured splenic artery. ConclusionsSplenic arteriopathy in VEDS is associated with variants that affect the structure and secretion of type III collagen and frequently present with rupture. Rupture and open repair are associated with high morbidity and mortality, whereas embolization is associated with favorable outcomes. Suggest repair considerations at SAA diameter of 15 mm. Long-term follow-up is indicated as secondary splenic arteriopathy can occur.

感染性心内膜炎による脾炎からの脾臓破裂を来した1例(A case of splenic rupture owing to splenitis caused by infective endocarditis)

要旨感染性心内膜炎の合併症として，まれではあるが脾臓破裂がある。脾臓破裂は，感染性心内膜炎のために，脾臓に梗塞，膿瘍，感染性動脈瘤を形成し，その後破裂することが多いとされる。しかし，今回我々は，梗塞，膿瘍，感染性動脈瘤形成が認められず，感染性心内膜炎からの脾炎による脾臓破裂というまれな症例を経験したので報告する。症例は55歳の男性。発熱を主訴に入院し，血液培養でStreptococcus oralisが検出され，心臓超音波検査で僧帽弁に15mm大の疣贅を認め感染性心内膜炎と診断され，抗菌薬治療を行っていた。重度の僧帽弁逆流症を認めており，早期手術の方針であった。しかし，術前検査中に急性期脳梗塞，脳出血を認めたため，待機的手術の方針に変わった。その後の入院中に突然左側腹部痛と血圧低下を認め，ショック状態となり，CTで脾臓出血の診断で緊急脾臓摘出術が行われた。摘出脾臓の病理診断では，梗塞，膿瘍，感染性動脈瘤は認められず，びまん性に好中球浸潤が散見され，急性脾炎からの脾臓破裂と診断された。

Application of channel screw combined with skin-stretching technique in treatment of pelvic fracture with severe Morel-Lavallée lesion

To investigate the effectiveness of channel screw combined with skin-stretching technique in treatment of pelvic fracture with severe Morel-Lavallée lesion. Between January 2017 and May 2020, 11 patients with pelvic fractures complicated with severe Morel-Lavallée lesions were treated with channel screw combined with skin-stretching technique. There were 8 males and 3 females, with an average age of 39.2 years (range, 28-58 years). Causes of injury included traffic accident in 9 cases and falling from hight in 2 cases. The time from injury to hospital admission ranged from 1 to 6 days (mean, 3.7 days). According to the Tile classification, the pelvic fractures were rated as type C1 in 7 cases, type C2 in 3 cases, and type C3 in 1 case. The sites of Morel-Lavallée lesions were buttocks in 8 cases, hips in 2 cases, and thigh in 1 case. There was 1 case of rectal injury, 1 case of splenic rupture, 3 cases of craniocerebral injury, 2 cases of chest injury, 4 cases of spinal fracture, and 6 cases of sacral nerve injury. X-ray films were performed to observe reduction and healing of fracture. The quality of fracture reduction was evaluated by Matta standard at 1 week after operation. Wound healing and complications were observed. Majeed scoring was used to evaluate hip function and Gibbons sacral nerve injury grading was used to evaluate neurological function recovery. The patients underwent 4-7 operations, with an average of 5.8 operations. The time of first operation (pelvic fracture fixation, debridement, and skin distractor installation) was 115-275 minutes, with an average of 186.5 minutes. The amount of intraoperative blood loss was 30-80 mL, with an average of 45.5 mL. All patients were followed up 6-12 months, with an average of 8.3 months. The quality of fracture reduction according to the Matta standard was excellent in 7 cases, good in 2 cases, and fair in 2 cases, with an excellent and good rate of 81.8%. All fractures healed at 3-6 months after operation, with an average of 4.5 months. At last follow-up, the hip functions were excellent in 7 cases and good in 4 cases according to Majeed scoring, with an excellent and good rate of 100%. Among the 6 patients complicated with sacral nerve injury, the Gibbons sacral nerve injury grading reached gradeⅠ for 4 cases, gradeⅡ for 1 case, and grade Ⅲ for 1 case. The wounds of 9 cases were sutured directly after skin-stretching treatment for 25-32 days, with an average of 28 days. The dermal edge necrosis occurred in 1 case, and the defect was repaired by free skin grafting. The skin superficial dry necrosis of the wound occurred in 1 case, and healed by dressing change. In the treatment of pelvic fracture complicated with severe Morel-Lavallée lesion, the channel screw and skin-stretching technique showed their own advantages, which can obtain early fracture fixation and good wound healing.

Splenic Rupture in a COVID-19 Patient – Case Report

Background: It is well known that Coronavirus disease 2019 (COVID-19) causes coagulation changes, requiring frequent monitoring for potential sequelae such as myocardial infarction and stroke. Non-traumatic splenic rupture is a rare and poorly understood occurrence in the clinical setting. Possible causes of nontraumatic splenic rupture include neoplasm, infection, inflammatory disease, iatrogenic and mechanical causes. Furthermore, increased intrasplenic tension, increased abdominal pressure, and thrombotic vascular occlusion are three possible mechanisms.&#x0D; The Case: We report a case of splenic rupture in a COVID-19 patient. Our patient was a 52 year old black man, presenting with diarrhea and moderate dyspnea, who was found to be COVID-19 positive. He had a past medical history significant for end-stage renal disease, chronic anemia, and aortic valve replacement. In an otherwise uneventful, 7-day hospital course, the patient’s stay abruptly resulted in a nontraumatic splenic rupture and demise. In this report, we have evaluated the likelihood of COVID-19 causing splenic rupture in a patient with no prior splenic disease.&#x0D; Conclusion: This case highlights the possibility of splenic rupture in otherwise normally recovering COVID-19 patients, particularly in the presence of comorbid conditions of renal failure and anticoagulation, with increased abdominal pressure during routine defecation. This information may assist in furthering the pathophysiology of COVID-19 and its life-threatening complications. In patients with COVID-19, non-traumatic splenic rupture should be considered as one of the differential diagnosis in patients who present with abdominal pain and early recognition of the same, owing to a high index of suspicion, can be lifesaving.

Real World Risk of Splenic Rupture with G-CSF/GM-CSF Therapy: A Pharmacovigilance Assessment Using FDA Adverse Event Reporting System (FAERS) Database

Introduction Splenic rupture is a rare but serious adverse event associated with the use of Granulocyte-Colony Stimulating Factor (G-CSF) and Granulocyte Macrophage-Colony Stimulating Factor (GM-CSF). Instances of spontaneous splenic rupture following administration of these hematopoietic growth factors have been sporadically documented in case reports. We aimed to conduct a more comprehensive study to generate signal for splenic rupture with G-CSF/GM-CSF therapy using disproportionality analysis. Methods The United States Food and Drug Administration (FDA) Adverse Events Reporting System (FAERS) database, a pharmacovigilance database, was used to extract data. All reported splenic rupture cases between January 1, 1991 and December 31,2019 for G-CSF or GM-CSF were collected by using the search terms "Pegfilgrastim", "Filgrastim", "Lenograstim", "Filgrastim-sndz", "Sargramostim" and "Pegfilgrastim-jmdb". We used reporting odds ratio (ROR) for proportionality analysis. ROR was calculated by SPSS 26 and considered significant with p value &amp;lt;0.05 when lower limit of 95% Confidence Interval (CI) of a ROR signal exceeded 1.0. Results Total of 58,725 reports of adverse reactions linked to G-CSF and GM-CSF were extracted from FAERS database. Out of these, splenic rupture was included as adverse event in 100 cases (Table 1). The median age of diagnosis was 54 years (interquartile range 46-62). Gender was reported in 92 cases, out of which 47 were male and 45 females. Final outcomes of 100 patients with growth factor associated splenic rupture showed that 31 were hospitalized, 30 had life-threatening illness and 18 died. ROR was calculated separately for Pegfilgrastim 16.03 (95% CI 11.90-21.59), Filgrastim (49.79; 36.32-68.26), Lenograstim (133.82; 55.39-323.32), Filgrastim-sndz (87.87; 28.21-273.71), Filgrastim+Pegfilgrastim (35.01; 11.26-108.85), Filgrastim+Sargramostim (895.20; 214.83-3730.27) and for all G-CSF/GM-CSF drugs taken together (28.13; 22.92-34.52). All calculated RORs were significant (Table 2). Conclusion This study demonstrates disproportionately elevated signals of developing splenic rupture in patient receiving G-CSF/GM-CSF therapy as compared to those receiving other drugs based on the FAERS database. Physicians should be aware of this rare adverse event as it could potentially lead to life-threatening outcomes. Disclosures Kumar: Amgen:Current equity holder in publicly-traded company;Bristol-Myers Squibb:Current equity holder in publicly-traded company;AstraZeneca:Current equity holder in publicly-traded company;Aveo Pharma:Current equity holder in publicly-traded company;Viking Therapeutics:Current equity holder in publicly-traded company;Acadia Pharma:Current equity holder in publicly-traded company;Iovance Biosciences:Current equity holder in publicly-traded company;AIKIDO:Current equity holder in publicly-traded company;CRISPR Therapeutics:Current equity holder in publicly-traded company;PTC Therapeutics:Current equity holder in publicly-traded company;ELiLilly:Current equity holder in publicly-traded company;Bio Path Holdings:Current equity holder in publicly-traded company;Northwest Bio:Current equity holder in publicly-traded company;Vertex Pharmaceuticals:Current equity holder in publicly-traded company;Precision Biosciences:Current equity holder in publicly-traded company;Cara Therapeutics:Current equity holder in publicly-traded company;IDEXX Laboratories:Current equity holder in publicly-traded company;Editas Medicine:Current equity holder in publicly-traded company;ChemBio Diagnostics:Current equity holder in publicly-traded company;Beyond Spring:Current equity holder in publicly-traded company;Poseida Therapeutics:Current equity holder in publicly-traded company;Spectrum Pharmaceuticals Inc.:Current equity holder in publicly-traded company;Cardiff Oncology:Current equity holder in publicly-traded company;Contrafect Corp:Current equity holder in publicly-traded company;Globus Medicine Inc.:Current equity holder in publicly-traded company;Johnson and Johnson:Current equity holder in publicly-traded company;AbbVie:Current equity holder in publicly-traded company;Five Prime Therapeutics:Current equity holder in publicly-traded company;ADMA Biologics:Current equity holder in publicly-traded company;CVS Health:Current equity holder in publicly-traded company;AGNEUS:Current equity holder in publicly-traded company;Biotelemetry Inc.:Current equity holder in publicly-traded company;Pfizer:Current equity holder in publicly-traded company.

Traumatic splenic rupture in pregnancy with favourable pregnancy outcome: Case report

Trauma complicating pregnancy is one of the causes of deaths that are not captured in the maternal mortality ratio, yet it occurs in about 1 in 15 pregnancies. This is a report of a case of splenic rupture occurring after a vehicle hit a pregnant woman who was a pedestrian. Splenectomy was done and, in spite of having a hemoperitoneum of about 2 litres, she recovered without further complication and was able to sustain the pregnancy to term, with the delivery of a healthy female infant. Clinicians should seek to exclude splenic rupture in cases of blunt trauma to the abdomen during pregnancy because of the risk of severe haemorrhage, shock, and possibility of pregnancy loss.

A Case of Splenic Rupture due to Enlargement and Torsion of a Wandering Spleen in Infectious Mononucleosis

A Case of Splenic Rupture due to Enlargement and Torsion of a Wandering Spleen in Infectious Mononucleosis

Spontaneous splenic rupture in Plasmodium knowlesi malaria

BackgroundPlasmodium knowlesi, a malaria parasite typically found in long-tailed and pig-tailed macaques, is the most common cause of human malaria in Malaysian Borneo. Infections in humans result in a spectrum of disease, including fatal outcomes. Spontaneous splenic rupture is a rare, but severe complication of malaria and has not been reported previously for knowlesi malaria.Case presentationA 46-year-old man presented with fever and acute surgical abdomen with concomitant P. knowlesi malaria infection at Kapit Hospital. He was in compensated shock upon arrival to the hospital. He had generalized abdominal tenderness, maximal at the epigastric region. Bedside focused abdominal ultrasonography revealed free fluid in the abdomen. He underwent emergency exploratory laparotomy in view of haemodynamic instability and worsening peritonism. Intraoperatively, haemoperitoneum and bleeding from the spleen was noted. Splenectomy was performed. Histopathological examination findings were suggestive of splenic rupture and presence of malarial pigment. Analysis of his blood sample by nested PCR assays confirmed P. knowlesi infection. The patient completed a course of anti-malarial treatment and recovered well post-operation.ConclusionsSpontaneous splenic rupture is a rare complication of malaria. This is the first reported case of splenic rupture in P. knowlesi malaria infection. Detection of such a complication requires high index of clinical suspicion and is extremely challenging in hospitals with limited resources.

Unusual Complications From Babesia Infection: Splenic Infarction and Splenic Rupture in Two Separate Patients

BackgroundBabesiosis is a zoonotic parasitic infection transmitted by the tick, Ixodes scapularis. Splenic infarct and rupture are infrequent complications of Babesia parasitemia, and have not been previously reported in the emergency medicine literature. Case ReportWe present two separate cases seen within 1 month at our institution: a case of splenic rupture and another case of splenic infarction due to Babesia parasitemia. Why Should an Emergency Physician Be Aware of This?Babesia infection in humans is increasingly prevalent in both the United States and worldwide, and clinical manifestations can range from subclinical to fulminant infections. An unusual but potentially fatal complication of babesiosis is splenic infarctions and rupture. Due to the endemicity of this parasite, a careful history and level of suspicion will enable the emergency physician to consider and test for babesiosis in patients with splenic injuries and without obvious traditional risk factors.

Non-traumatic splenic rupture - a rare first presentation of diffuse large B-cell lymphoma and a review of the literature

BackgroundCases of non-traumatic splenic rupture are rare and entails a potentially grave medical outcome. Hence, it is important to consider the differential diagnosis of a non-traumatic splenic rupture in patients with acute or insidious abdominal pain. The incidence of rupture in Diffuse B-cell non-Hodgkin Lymphoma is highly infrequent (Paulvannan and Pye, Int J Clin Pract 57:245–6, 2003; Gedik et el., World J Gastroenterol 14:6711–6716, 2008), despite reports of various non-traumatic splenic rupture in the literature (Orloff and Peksin, Int Abstr Surg 106:1-11, 1958; Paulvannan and Pye, Int J Clin Pract 57:245–6, 2003). In this article, we attempt to highlight the features of a rare cause of splenic rupture that might serve as a future reference point for the detection of similar cases during routine clinical practice.Case presentationA 40-year-old man presented with 1 week history of left hypochondriac pain associated with abdominal distention. There was no history of preceding trauma or fever. Clinical examination revealed signs of tachycardia, pallor and splenomegaly. He had no evidence of peripheral stigmata of chronic liver disease. In addition, haematological investigation showed anemia with leucocytosis and raised levels of lactate dehydrogenase enzyme. However, peripheral blood film revealed no evidence of any blast or atypical cells. In view of these findings, imaging via ultrasound and computed tomography of the abdomen was performed. The results of these imaging tests showed splenic collections that was suggestive of splenic rupture and hematoma. Patient underwent emergency splenectomy and the histopathological report confirmed the diagnosis as DLBCL.ConclusionsThe occurrence of true spontaneous splenic rupture is uncommon. In a recent systematic review of 613 cases of splenic rupture, only 84 cases were secondary to hematological malignancy. Acute leukemia and non-Hodgkin lymphoma were the most frequent causes of splenic rupture, followed by chronic and acute myelogeneous leukemias. At present, only a few cases of diffuse large B-cell lymphoma (DLBCL) have been reported. The morbidity and mortality rate is greatly increased when there is a delay in the diagnosis and intervention of splenic rupture cases. Hence, there should be an increased awareness amongst both physicians and surgeons that a non-traumatic splenic rupture could be the first clinical presentation of a DLBCL.

Splenic Trauma in the Israeli Defense Forces - Do Not Underestimate Minor Trauma.

The spleen is the most commonly damaged abdominal organ following blunt abdominal trauma (BAT), usually involving a major injury mechanism. Several cases of splenic rupture caused by minor BAT in the Israeli Defense Forces (IDF) have recently occurred. This led us to explore the demographics and mechanisms of trauma resulting in splenic injury among IDF personnel. All cases of splenic injury between 2007 and 2015 were pulled from the computerized patient records of the IDF. Data regarding patient demographics, injury mechanism, presenting symptoms, treatment, and outcomes were collected. Three independent physicians graded the injury mechanism as major or minor. Fifty-two cases of splenic injury were identified. Of them, 82.7% resulted from a blunt trauma, 9.6% occurred after a penetrating trauma and 7.7% occurred spontaneously. 37.2% of BAT were unanimously considered as minor. Patients who suffered minor trauma were more likely to experience delayed diagnosis (85.7% vs. 0% p < 0.0001) and had significantly less concomitant injuries (12.5% vs. 88.8% p < 0.0001). The presentation, treatment, and outcome of the patients were similar, regardless of the severity of trauma mechanism. Our findings indicate that although minor BAT results from a milder traumatic mechanism, it is a significant cause of splenic injury among active duty personnel. We suggest that military physicians maintain a high level of suspicion while managing minor BAT cases.

Splenic Rupture in Children With Portal Hypertension.

Massive splenomegaly from portal hypertension (PHTN) in children raises the specter of splenic rupture; however, the incidence, etiology, and risk of rupture have not been studied, nor have existing practices to reduce risk. We therefore performed an international survey to describe the splenic rupture cases in PHTN and to describe the existing empirical practice among hepatologists. A questionnaire was constructed to elicit cases of splenic rupture and collect hepatologists' common practices for prevention of splenic rupture. Pediatric hepatologists working in selected tertiary academic centers in the United States, Canada, and the United Kingdom were contacted. Hepatologists from 30 of 35 centers who met the inclusion criteria replied to the survey. Thirteen cases of splenic rupture were described of which 11 resulted from trauma. In the opinion of the practitioners, high-risk activities were football, hockey, and wrestling. Sixty-one percent recommended total restriction from high-risk activities. Seventy-four percent stated that platelet count had no effect on this decision and 61% advised a spleen guard for certain activities. Splenic rupture in patients with PHTN and splenomegaly seems to be rare. The reported splenic rupture cases were mostly related to falling (and not to participation in sports). There was general agreement among hepatologists about restricting high impact sports. There was variation in recommendations regarding the use of a spleen guard. The authors recommend use of spleen guards in children with splenomegaly from PHTN for physical activities with risk of fall or blunt abdominal trauma.

Case Report: Splenectomy Due to Splenic Rupture after Caesarian Section

Background: Splenic rupture with high maternal mortality is an exceedingly rare complication after pregnancy. Unfortunately, the diagnosis is often missed because of different diagnoses such as uterine rupture and abruption of placentae. Hereon we present a case of splenic rupture that manifested post caesarian section and she was treated with laparotomy and SplenectomyCase: A 33 years old, gravida3, para 2, woman presented at 38 weeks of gestational age and gestational hypertension to Chabahar general hospital ,the patient was planned to do emergency caesarian section due to repeat caesarian section , 3 days after surgery, she was referred with dyspnea and oliguria .The patient was transferred to Imam Ali Hospital of Zahedan city for diagnosis and treatment because of low HB and oliguria , the patient underwent re-laparotomy and acute spleen rupture was suspected ,surgery intervention performed Splenectomy .She had an uneventful recovery and was discharged 7days after SplenectomyConclusion: Splenic rupture in pregnancy is a life-threatening complication. Early diagnosis and surgical intervention will allow for optimal maternal and perinatal outcome.

Splenic rupture following synchronised direct current cardioversion

Atraumatic rupture of the normal spleen is a rare entity. Often, a triggering factor or minor physical event can be ascribed as the aetiology for rupture, including coughing, vomiting or...

Splenic rupture due to metastatic disease: a rare complication

We report a case of splenic rupture in an 83-year-old woman presenting with symptoms concerning for upper gastrointestinal malignancy. CT imaging revealed marked gastric thickening and a 33×33 mm splenic...

P-017A 脾動脈塞栓術を行った外傷性脾損傷3例の治験(肝・胆道3, 第44回日本小児外科学会学術集会)

P-017A 脾動脈塞栓術を行った外傷性脾損傷3例の治験(肝・胆道3, 第44回日本小児外科学会学術集会)

Atraumatic splenic rupture cases presenting with hemorrhagic shock and coagulopathy treated by splenic artery occlusion using a microballoon catheter before splenectomy

Atraumatic splenic rupture (ASR) is an uncommon pathologic condition in which bleeding from the spleen occurs for a variety of nontraumatic reasons. While the current trend in traumatic splenic rupture is nonoperative management including transcatheter arterial embolization, the current recommendation for the treatment of most patients with ASR is splenectomy. In this report, we describe two cases of ASR presenting with hemorrhagic shock and complicated by anticoagulation therapy. In patients with severe hemorrhagic shock and coagulopathy, a damage control strategy is recommended. Our successful treatment of these patients included a three-step strategy as a damage control: (i) rapid transient hemostasis by splenic artery occlusion using a microballoon catheter, (ii) damage control resuscitation and (iii) splenectomy as a definitive hemostatic treatment.

Colonoscopy-Induced Splenic Injury: An Unusual Complication Warranting Urgent Attention

Colonoscopy is a safe, well-tolerated procedure routinely performed for diagnostic and therapeutic purposes of colorectal diseases. Although splenic injury is an uncommon complication, it is associated with a significant morbidity and mortality. Therefore, splenic injury should always be in the differential in any patient with abdominal pain or hemodynamic instability during or following colonoscopy. We present a case of splenic rupture during an elective colonoscopy. J Med Cases. 2014;5(10):541-544 doi: http://dx.doi.org/10.14740/jmc1817w