Cases Of Splenic Injury Research Articles

Management of Splenic Injury During Percutaneous Nephrolithotomy: Report of Two Cases

Percutaneous nephrolithotomy (PCNL) has become the standard of care for the removal of kidney stones >2 cm. Major complications, although rare, are between 1% and 7%. Splenic injury during PCNL is rare and can often be managed conservatively, but has the potential to be devastating, necessitating the importance of early diagnosis. Our team describes two cases of splenic injury during PCNL with emphasis on diagnosis and management. Although both cases were managed conservatively through close monitoring and prolonged nephrostomy tube presence, one case had a concurrent pneumothorax. Both cases were diagnosed primarily through postprocedure CT imaging. Risk factors primarily include supracostal access and splenomegaly. Splenic injury is a rare complication that can often be managed conservatively; however, prompt recognition of injury is important. We present in this study two cases of conservative splenic injury management sustained during PCNL.

1468 Left-Sided Chest Pain Following Colonoscopy: Think Outside the Colon!

INTRODUCTION: Colonoscopy is considered to be a low risk procedure performed regularly worldwide. The most common complications include hemorrhage and bowel perforation which are 1% and 0.1% respectively. The incidence of spleen rupture is estimated to be between 0.00005 and 0.017%. However, due to its nonspecific presentation many cases may be misdiagnosed and up to 11% of these patients will be discharged with a different diagnosis. Therefore, the actual incident is likely higher. We present a case of a 76-year-old female with spleen rupture 16 days after a routine colonoscopy. CASE DESCRIPTION/METHODS: 76-year-old female with past medical history of atrial fibrillation on apixaban, coronary artery disease, recurrent bladder cancer and chronic obstructive pulmonary disease presented for sudden onset of chest pain. Pain was 10/10 in intensity and located in the left anterior chest wall with radiation to the left shoulder. She also had associated nausea without vomiting. Patient denied any history of trauma. Patient underwent an uncomplicated colonoscopy 16 days earlier during which a 1.3 cm polyp was excised. Upon presentation, vital signs were significant for a blood pressure of 96/58. Labs were significant for hemoglobin of 7.2 and INR of 1.6. CT scan of the abdomen showed findings suspicious for splenic rupture. Patient received 2 units of packed RBCs in the ED and was then taken to the OR for emergent exploratory laparotomy. Intra-operatively, the spleen was found to be ruptured and splenectomy was performed. She did not have any complications during or after the splenectomy and was discharged 6 days after the procedure in stable condition. Appropriate vaccinations were administered upon discharge. DISCUSSION: There are many proposed mechanisms for spleen injury during colonoscopy; these include tension on the splenocolic ligament, tension on pre-existing intra-abdominal adhesions and direct injury to the spleen during passage of the colonoscope through the splenic flexture. We speculate that our patient's use of apixaban might have played a contributing role. To our knowledge, only 5 cases of splenic injury have been previously reported with time of presentation greater than 16 days post-colonoscopy. Our patient's symptoms and location of pain are not typical for splenic injury. With our case, we intend to spread awareness about this not so uncommon and possibly fatal complication of colonoscopy with delayed and sometimes atypical symptoms.

Diagnosis and management of splenic injury following colonoscopy: algorithm and case series.

Splenic injury following colonoscopy is a rare yet life-threatening complication. These injuries are often associated with delayed diagnosis and may require invasive intervention. We sought to study the emergent presentation associated with splenic injury post-colonoscopy and to suggest a new treatment algorithm. Six cases of splenic injury following colonoscopy were collected from three medical centers. Data regarding patient medical history, clinical presentation, laboratory and imaging findings and clinical management were recorded. A systematic PubMed/MEDLINE search was performed. Non-English-language publications and publications dating earlier than 2010 were excluded. An emergency department trauma-based management algorithm was designed according to the identified publications and review of the available trauma literature. The mean age was 65.3 years and the male-to-female ratio was 1:5. Five of the cases presented within 24 h of the colonoscopy complaining of severe abdominal pain. Hemodynamic instability was noted in four patients who presented with tachycardia (105-130), hypotension and/or a rapid drop in hemoglobin levels. All of the patients underwent initial resuscitation and a computerized abdominal tomography scan. Four of them required emergent splenectomy. No mortality or major morbidity was reported following the hospitalization. Although very rare, splenic injury during colonoscopy is an acute, severe and possible fatal complication. Patients may present with a rapid clinical deterioration and hemodynamic instability. Physicians should be familiar with the practical management of this surgical emergency and the treatment options available.

Post Colonoscopy Splenic Injuries: Case Series and Recommendations

Splenic injury is an uncommon, but serious complication of colonoscopy. Any cause of excessive spleno-colic adhesions, splenomegaly, or underlying splenic disease would be a predisposing factor for splenic injury during colonoscopy. A delay in diagnosis has been noted as many physicians are not aware of this complication of colonoscopy. We report two cases of splenic injury secondary to screening colonoscopy. The first refers to a 61-year-old male, who was involved in a motor vehicle accident a month prior to the procedure; with the second case that of a 46-year-old healthy female. Clinical, biochemical and radiological findings were suggestive of a splenic rupture and hemoperitoneum. Both patients had grade III splenic ruptures with hemodynamic instability, which warranted urgent splenectomy. Both patients had an uneventful recovery. Proposed mechanisms are traction on the spleno-colic ligament leading to splenic capsule avulsion or direct splenic trauma due to colonoscopic manipulation. So-called “ looping of the colonoscope ” in the bowel, followed by aggressive straightening can cause strain on the spleno-colic ligament and tearing of blood vessels. The presence of Kehr ’ s sign in an hemodynamically unstable patient is a very sensitive pointer towards splenic rupture. Patients with recent abdominal trauma should be properly screened with appropriate history and investigations prior to colonoscopy. CT scan of the abdomen is the test of choice for the evaluation of splenic injury. Splenectomy is the most commonly performed procedure for post-colonoscopy injuries of the spleen. doi: http://dx.doi.org/10.4021/jmc1498w

Milzverletzung als Komplikation der thorakoskopisch assistierten ventralen Stabilisierung von thorakolumbalen Wirbelkörperfrakturen – 2 Fallberichte

Minimally invasive procedures for additive ventral stabilisation of dorsal instrumented unstable burst fractures of the thoracolumbar spine have been developed. Typical complications of these standardised techniques have been described in the past. Only limited data exist on injury to upper abdominal organs associated with minimally invasive spondylodesis. We report two cases of splenic injury after thoracoscopic-assisted ventral stabilisation of incomplete burst fractures. Retraction of the diaphragm might be the main factor causing this complication. In conclusion, splenic injury is a rare but potentially lethal complication in the operative treatment of thoracolumbar fractures. Therefore postoperative abdominal sonography should routinely be done and in case of haemodynamic instability the possibility of splenic injury must be considered as part of the differential diagnosis.

The Role of Laparoscopy in the Treatment of Complications After Colonoscopy

Perforations of the colonic wall or splenic injury during colonoscopy are rare complications. Treatment of these complications by laparoscopy is an advisable compromise instead of an invasive surgery with a laparotomy or a noninvasive and potentially risky nonoperative therapy. All surgical procedures that can be performed by open approach can also be performed laparoscopically. We present in this report 15 patients who were treated for a perforation after colonoscopy. In addition, 2 cases of splenic injury after colonoscopy are described. Twelve perforations were sutured laparoscopically and 3 perforations were sutured via laparotomy. Except for 1 minor wound infection, there were no complications. One splenic injury was treated by spleen wrapping via an open approach due to former pancreatic surgery, and 1 injury was treated laparoscopically with a hemostypticum. Mortality was 0%. Early laparoscopic intervention is a safe and effective method in the treatment of serious complications after colonoscopy.

Splenic Injury: Rare Complication of Percutaneous Nephrolithotomy: Report of Two Cases with Review of Literature

Splenic injury is an uncommon complication of percutaneous nephrolithotomy (PCNL). We report herewith two cases of splenic injury that occurred during puncture of the 10th intercostal-space for PCNL. One of these patients presented with hypotension on day 5 after discharge from the hospital. Both patients needed emergency laparotomy, and one of them required splenectomy for management of the injury. We reviewed the literature to determine the risk factors and management of splenic injury during PCNL.

Splenic Rupture: An Unusual Complication of Colonoscopy

Splenic injury is a known, albeit rare, complication of diagnostic and therapeutic colonoscopy. Within a 6-month period, we observed two colonoscopic splenic injuries. We report these two cases of splenic injury who presented differently after colonoscopy: one presented as frank hemorrhagic shock, and the other as a subacute splenic hemorrhage with symptomatic anemia. The first patient presented with hemorrhagic shock several hours after a diagnostic colonoscopy and required an emergency splenectomy. The second patient presented with symptomatic anemia several days after a diagnostic colonoscopy and was treated by angiographic embolization. Clinical presentation and discussion of the mechanisms of injury, available treatment options, and strategies for preventing colonoscopic splenic injuries are presented. Awareness of this complication is paramount in early recognition and management of this potentially life-threatening injury.

Splenic repair for trauma.

The risks of overwhelming post-splenectomy infection (OPSI) are now well documented both in children and adults. Although the incidence of OPSI is comparatively low following splenectomy for trauma, it has a high mortality. Splenectomy is no longer the treatment of choice for splenic injury and splenic salvage is recommended whenever feasible. Since 1982, in the Isle of Wight hospitals, 13 cases of splenic injury following trauma have been treated applying various salvage procedures and are reported here.

Splenic Injury as a Complication of Endoscopy: Two Case Reports and a Literature Review

Two cases of splenic injury - one after a difficult colonoscopy and the other after routine ERCP - are reported. Splenic injury as a complication of endoscopic procedures is relatively rare, but over the past several years this complication has been increasingly reported. Review of the literature revealed 11 cases occurring after colonoscopy and one after ERCP. Although most of the patients presented with acute abdominal symptoms, some had mild vague symptoms. In two cases the injury was overlooked entirely. Diagnosis was established at laparotomy in four cases, by CT in four, by ultrasonography in two, by chance observation in two, by angiography in one and by paracentesis in one. All patients except the most recent three reported underwent surgery, with one mortality occurring three weeks after the operation.

SPLENORRHAPHY IN THE MANAGEMENT OF SPLENIC INJURY

A retrospective study of 301 adult splenic injuries presenting to the Princess Alexandra Hospital during a 15 year period, from 1970 to 1984, was conducted. Particular attention was paid to the last 5 years during which 25% of the ruptured spleens were preserved. The details of the preserved spleens are discussed. Respiratory infections were the only complications in this same selected group of patients; the complication rate being higher in the splenectomy group (15.8%) than the splenorrhaphy group (6.25%). None of the cases of splenorrhaphy required re-operation for continued haemorrhage. Twenty-five per cent of all cases of splenic injury had associated intra-abdominal injury which, of its own nature, would require laparotomy. A policy of operative management for splenic injury in adults with major trauma is therefore proposed because of the rate of associated intra-abdominal injuries. When laparotomy is performed, splenorrhaphy should be considered because of the now widely acknowledged risks of diminished immunological competence and overwhelming sepsis in asplenic individuals.