Splenic Hemorrhage Research Articles

Outbreak of H5N2 highly pathogenic avian Influenza A virus infection in two commercial layer facilities: lesions and viral antigen distribution.

The largest outbreak of highly pathogenic avian Influenza A virus (HPAIV) infection in U.S. history began in December 2014 resulting in the euthanasia of millions of birds and collateral economic consequences to the U.S. poultry industry. We describe 2 cases of H5N2 HPAIV infection in laying hens in Iowa. Following a sharp increase in mortality with minimal clinical signs, 15 dead birds, from 2 unrelated farms, were submitted to the Iowa State University Veterinary Diagnostic Laboratory. Common lesions included diffuse edema and multifocal hemorrhage of the comb, catarrhal exudate in the oropharynx, and multifocal tracheal hemorrhage. Less common lesions included epicardial petechiae, splenic hemorrhage, and pancreatic necrosis. Influenza A virus nucleoprotein was detected by immunohistochemistry in multiple cell types including ependymal cells, the choroid plexus, neurons, respiratory epithelium and macrophages in the lung, cardiac myocytes, endothelial cells, necrotic foci in the spleen, Kupffer cells in the liver, and necrotic acinar cells in the pancreas. Real-time polymerase chain reaction and sequencing confirmed H5N2 HPAIV with molecular characteristics similar to other contemporary U.S. H5N2 HPAIVs in both cases.

Management of splenic and pancreatic trauma

The spleen and pancreas are at risk for injury during abdominal trauma. The spleen is more commonly injured because of its fragile structure and its position immediately beneath the ribs. Injury to the more deeply placed pancreas is classically characterized by discordance between the severity of pancreatic injury and its initial clinical expression. For the patient who presents with hemorrhagic shock and ultrasound evidence of major hemoperitoneum, urgent "damage control" laparotomy is essential; if splenic injury is the cause, prompt "hemostatic" splenectomy should be performed. Direct pancreatic injury is rarely the cause of major hemorrhage unless a major neighboring vessel is injured, but if there is destruction of the pancreatic head, a two-stage pancreatoduodenectomy (PD) may be indicated. At open laparotomy when the patient's hemodynamic status can be stabilized, it may be possible to control splenic bleeding without splenectomy; it is always essential to search for injury to the pancreatic duct and/or the adjacent duodenum. Pancreatic contusion without ductal rupture is usually treated by drain placement adjacent to the injury; ductal injuries of the pancreatic body or tail are treated by resection (distal pancreatectomy with or without splenectomy), with generally benign consequences. For injuries of the pancreatic head with pancreatic duct disruption, wide drainage is usually performed because emergency PD is a complex gesture prone to poor results. Postoperatively, the placement of a ductal stent by endoscopic retrograde catheterization may be decided, while management of an isolated pancreatic fistula is often straightforward. Non-operative management is the rule for the trauma victim who is hemodynamically stable. In addition to the clinical examination and conventional laboratory tests, investigations should include an abdominothoracic CT scan with contrast injection, allowing identification of all traumatized organs and assessment of the severity of injury. In this context, non-operative management (NOM) has gradually become the standard as long as the patient remains hemodynamically stable and there is no suspicion of injury to hollow viscera, with the patient being carefully monitored on a surgical service. The development of arteriography with splenic artery embolization has increased the rate of splenic salvage; this can be performed electively based on specific indications (blush on CT, pseudoaneurysm, arteriovenous fistula), and may also be considered for severe splenic injury, abundant hemoperitoneum, or severe polytrauma. For pancreatic injury, in addition to CT scan, magnetic resonance pancreatography (MRCP) or even endoscopic retrograde cholangiopancreatography (ERCP) may be necessary to identify a ductal rupture. If the pancreatic duct is intact, laboratory and CT imaging surveillance is performed just as for splenic injury. In case of pancreatic ductal injury, ERCP stenting can be considered. However, if this is unsuccessful, the therapeutic decision can be difficult: while NOM can still be successful, complications may arise that are difficult to treat while distal pancreatectomy, although initially more agressive may avoid these complications if performed early.

Influences of limited resuscitation with plasma or plasma protein solutions on hemostasis and survival of rabbits with noncompressible hemorrhage.

Plasma infusion with or without red blood cells is the current military standard of care for prehospital resuscitation of combat casualties. We examined possible advantages of early and limited resuscitation with fresh plasma compared with a single plasma protein or crystalloid solutions in an uncontrolled hemorrhage model in rabbits. Anesthetized spontaneously breathing rabbits (3.3 ± 0.1 kg) were instrumented and subjected to a splenic uncontrolled hemorrhage. Rabbits in shock were resuscitated at 15 minutes with Plasma-Lyte (PAL; 30 mL/kg), PAL + fibrinogen (PAL + F; 30 mL + 100 mg/kg), fresh rabbit plasma (15 mL/kg), or 25% albumin (ALB; 5 mL/kg) solution, all given in two bolus intravenous injections (15 minutes apart) to achieve a mean arterial pressure of 65 mm Hg, n = 8 to 9/group. Animals were monitored for 2 hours or until death, and blood loss was measured. Blood samples and tissues were collected and analyzed. There were no differences among groups in baseline measures and their initial bleeding volume at 15 minutes. At 60 minutes after injury, mean arterial pressure was higher with ALB than with crystalloids (PAL or PAL + F), but shock indices were not different despite the large differences in resuscitation volumes. Fibrinogen addition to PAL only increased clot strength. Plasma resuscitation increased survival rate (75%) without significant improvement in coagulation measures. Albumin administration replenished total plasma protein and increased survival rate to 100% (p < .05 vs. crystalloids). No histological adverse events were identified in the vital organs. Fibrinogen administration added to a compatible crystalloid did not improve hemostatic outcomes. Plasma resuscitation increased survival rate; however, its effects did not differ from those obtained with 25% ALB at one-third of the volume. The ALB advantage was consistent with our previous findings in which 5% ALB was used at a volume equal to plasma. The benefit of plasma for resuscitation may be mostly due to its ALB content rather than its coagulation proteins.

Splenic Hemorrhage at Altitude in a Patient with Undiagnosed Sickle-Cell Trait

Splenic Hemorrhage at Altitude in a Patient with Undiagnosed Sickle-Cell Trait

Spontaneous Rupture of Pancreatic Pseudocyst: Report of Two Cases.

Introduction. Pancreatic pseudocysts are a common complication of acute pancreatitis. Pancreatic pseudocyst's natural history ranges between its spontaneous regression and the settlement of serious complications if untreated, such as splenic complications, hemorrhage, infection, biliary complications, portal hypertension, and rupture. The rupture of a pancreatic pseudocyst to the peritoneal cavity is a dangerous complication leading to severe peritonitis and septic conditions. It requires emergent surgical exploration that is often of great technical difficulty and with important morbidity and mortality. Case Study. We present two cases of spontaneous rupture of pancreatic pseudocysts, managed differently according to the local and systemic conditions. Conclusion. The best surgical choice is the internal drainage of the cyst to the GI tract; however, in some conditions, the external drainage is the only choice available.

Chronic myeloid leukemia presenting as spontaneous hemoperitoneum at diagnosis in an adolescent girl: A case report with review of literature

Spontaneous hemoperitoneum as an initial presentation of chronic myeloid leukemia (CML) is rare and however if that occurs it is usually due to splenic hemorrhage. Corpus luteal hemorrhage which is common in child bearing women is a rare etiology of spontaneous hemoperitoneum in CML and it is rare in adolescent girls. We report an adolescent girl with CML presented with corpus luteal hemorrhage causing hemoperitoneum which to our best knowledge has never been reported before in literature. She was managed conservatively for hemoperitoneum and imatinib for CML. She is well with 1 year of follow-up now.

Haemorrhagic shock due to spontaneous splenic haemorrhage complicating antiplatelet therapy: endovascular management

Spontaneous splenic haemorrahge and rupture is a rare but life-threatening condition requiring urgent diagnosis and treatment. Splenic haemorrhage and rupture precipitated by thrombolytic or antiocoagulant therapy has been reported frequently in the literature, but only two cases due to ticlopidine and one case due to salicyclate have been reported. We report the case of a 54-year-old man with haemorrhagic shock due to spontaneous splenic haemorrhage and rupture following dual antiplatelet (aspirin and clopidogrel) therapy. He was successfully treated with selective angioembolization of the bleeding branch of the splenic artery.

Spontaneous rupture of primary splenic angiosarcoma: A case report

Primary angiosarcoma of the spleen is an extremely rare malignant neoplasm of vascular origin that often has a poor prognosis. The majority of cases presents with splenic rupture and hemorrhage. The present study retrospectively analyzed the case of 77-year-old female who presented with diffuse abdominal pain and distension. During laparotomy, a huge actively bleeding spleen was identified and a splenectomy was performed. Since an accurate diagnosis could not be achieved by abdominal computed tomography, a pathological examination was performed. The patient and the family refused post-operative adjuvant chemotherapy and radiation therapy. The patient succumbed to uncontrolled hemorrhagic shock and lung metastases at 2 weeks post-surgery.

Orthotopic transplantation of cryopreserved mouse ovaries and gonadotrophin releasing hormone analogues in the restoration of function following chemotherapy-induced ovarian damage.

Therapy advances are constantly improving survival rates of cancer patients, however the toxic effects of chemotherapy drugs can seriously affect patients’ quality of life. In women, fertility and premature ovarian endocrine dysfunction are of particular concern. It is urgently we find methods to preserve or reconstruct ovarian function for these women. This study compares GnRHa treatment with ovarian tissue cryopreservation and orthotopic transplantation in a chemotherapy-induced ovarian damage murine model. 56 inbred Lewis rats were divided into 4 treatment groups: Saline control (group I); cyclophosphamide only (group II); cyclophosphamide plus GnRHa (group III); cyclophosphamide and grafting of thawed cryopreserved ovaries (group IV). Body weight, estrous cycle recovery time, ovarian weight, morphology and follicle count, as well as breeding and fertility were compared among groups. Only group IV was able to restore to normal body weight by the end of the observation period and resumed normal estrous cycles in a shorter time compared to other treatment groups. There was a decrease in primordial follicles in all treatment groups, but group III had the greatest reduction. Although, there was no difference in pregnancy, only one animal littered normal pups in group II, none littered in group III and four littered in group IV. Thus, cryopreservation and orthotopic transplantation of ovarian tissue can restore the fertility of rats subjected to chemotherapy in a manner that is superior to GnRHa treatment. We also observed increased rates of hepatic, splenic and pulmonary haemorrhage in group III, suggesting there may be synergistic toxicity of GnRHa and cyclophosphamide.

Robotic approach improves spleen-preserving rate and shortens postoperative hospital stay of laparoscopic distal pancreatectomy: a matched cohort study.

Spleen preservation (SP) is beneficial for patients undergoing distal pancreatectomy of benign and borderline tumors; however, the conventional laparoscopy approach (C-LDP) is less effective in controlling splenic vessel bleeding. The benefits of the robotic-assisted approach (RA-LDP) in SP have not been clearly described. This study aimed to evaluate whether a robotic approach could improve SP rate and effectiveness/safety profile of laparoscopic distal pancreatectomy (LDP). Matched for scheduled SP, age, sex, ASA classification, tumor size, tumor location, and pathological type, 69 patients undergoing RA-LDP and 50 undergoing C-LDP between January 2005 and May 2014 were included. Main outcome measures included SP rate, operative time (OT), blood loss, transfusion frequency, morbidity, postoperative hospital stay (PHS), and oncologic safety. Among matched patients scheduled for SP, RA-LDP was associated with significantly higher overall (95.7 vs. 39.4%) and Kimura SP rates (72.3 vs. 21.2%), shorter OT (median 120 vs. 200 min), less blood loss (median 100 vs. 300 mL), lower transfusion frequency (2.1 vs. 18.2%), and shorter mean PHS (10.2 vs. 14.5 days). Among matched patients scheduled for splenectomy, RA-LDP was associated with similar OT, blood loss, transfusion frequency, and PHS. The two approaches were similar in overall morbidity, frequency of pancreatic fistula, and oncologic outcome among patients undergoing splenectomy for malignant tumors. RA-LDP was associated with a significantly better SP rate and reduced OT, blood loss, transfusion requirement, and PHS for patients undergoing SP compared to C-LDP, but offered less benefits for patients undergoing splenectomy.

Clinical safety of endoscopic submucosal dissection compared with surgery in elderly patients with early gastric cancer: a propensity-matched analysis

Little is known about the clinical and oncologic outcomes of endoscopic submucosal dissection (ESD) compared with surgery in elderly patients with early gastric cancer (EGC). To evaluate the clinical and oncologic outcomes of ESD compared with surgery in elderly patients with EGC of an expanded indication. Retrospective study with propensity-matched analysis. University-affiliated tertiary-care hospital, Seoul, South Korea. A total of 518 patients 70 years of age or older with initial-onset EGC. ESD and surgery. Clinical outcomes, disease-free survival, and overall survival. In a propensity-matched analysis of 132 pairs, the length of hospital stay of the ESD group was shorter than that of the surgery group (median [interquartile range], 4 [3-4] vs 9 [7-11] days; P< .001). Intensive care unit admission occurred in the surgery group only (7 patients [5.3%]). Two surgery-related deaths occurred in the surgery group (1 splenic artery bleeding and 1 anastomosis site leakage). During follow-up, metachronous lesions developed more often in the ESD group than in the surgery group (12 vs 2 lesions, P= .004). All recurred lesions were successfully treated endoscopically except for 3 patients who refused additional treatment. Overall survival did not differ between the 2 groups (P= .280). Nonrandomized, retrospective study. ESD is a safe procedure in elderly patients with EGC. Although the risk of metachronous lesions is higher in patients who undergo ESD than in those who undergo surgery, overall survival did not differ between the patients who undergo ESD and surgery.

Huang's three-step maneuver for laparoscopic spleen-preserving No. 10 lymph node dissection for advanced proximal gastric cancer.

Due to the complexity of the splenic hilar vessels, their anatomical variation and the narrow and deep space, as well as the bleeding-prone splenic parenchyma and the difficulty to manage splenic or vascular bleeding at the splenic hilum,the procedure remains challenging and technically demanding procedure for the performance of laparoscopic pancreas- and spleen-preserving splenic hilar lymph nodes dissection. Based on our experiences, we gradually explored a set of procedural operation steps called "Huang's three-step maneuver". In this paper, we not only provide the concrete operation steps for the surgeon, but we also provide our recommended technique of pulling and exposure for assistants. This new maneuver simplifies the complicated procedure and improves the efficiency of laparoscopic spleen-preserving splenic hilar lymphadenectomy, making it easier to master and allowing for its widespread adoption.

Diagnostic value of contrast enhanced ultrasound for splenic artery complications following acute pancreatitis

To assess the value of contrast-enhanced ultrasound (CEUS) in diagnosing splenic artery complications (SACs) after acute pancreatitis (AP). One hundred and eighteen patients with AP were enrolled in the study. All patients were examined by CEUS and contrast-enhanced computed tomography (CECT). CECT was accepted as a gold standard for the diagnosis of SACs in AP. The diagnostic accuracy of splenic CEUS and pancreatic CEUS was compared with that of CECT. Splenic infarction was the diagnostic criterion for splenic artery embolism and local dysperfusion of the splenic parenchyma was the diagnostic criterion for splenic arterial stenosis. The incidence of splenic sub-capsular hemorrhage, splenic artery aneurysms, and splenic rupture was all lower than that of SACs. Nine patients were diagnosed as having SACs after AP by CECT among the 118 patients. The patients with SACs were diagnosed with severe acute pancreatitis (SAP). Among them, 6 lesions were diagnosed as splenic artery embolism, 5 as splenic artery aneurysms, and 1 as splenic arterial stenosis. No lesion was diagnosed by pancreatic CEUS and 5 lesions were diagnosed by splenic CEUS. By splenic CEUS, 4 cases were diagnosed as splenic artery embolism and 1 as splenic arterial stenosis. The accuracy of splenic CEUS in diagnosis of SACs in SAP was 41.7% (5/12), which was higher than that of pancreatic CEUS (0%). Splenic CEUS is a supplementary method for pancreatic CEUS in AP patients, which can decrease missed diagnosis of SACs.

Delayed splenic rupture presenting as atypical chest pain and right bundle branch block

Introduction: Although splenic injury is the most frequent abdominal injury resulting from blunt trauma, delayed splenic rupture is a rare event. Traumatic rupture of the spleen has been well described in medical literature and is found in approximately 30% of patients undergoing surgery for blunt abdominal injury. Computed tomography negative delayed rupture of the spleen is a very rare clinical entity. This is in spite of computed tomography having a sensitivity and specificity for detection of splenic injuries as high as 96% and 100%, respectively. When a patient presents after blunt abdominal trauma, awareness of the problem of delayed splenic rupture, a high index of clinical suspicion and rapid diagnostic approach may help reducing the morbidity and mortality associated with unrecognized splenic injury and/or hemorrhage. Case Report: We present a case report of a 61­year­old male restrained driver, involved in a motor vehicle crash, who presented with a normal spleen on initial computed tomography scan. Conclusion: Computed tomography ­ negative delayed rupture of the spleen is a very rare clinical entity.

Domestic violence as an unfortunate cause of splenic injury, fetal demise, and maternal morbidity

Abuse of pregnant women is a serious health problem with the potential to cause life-threatening injuries to the mother and her baby. This is a case of domestic violence leading to splenic injury and massive intraperitoneal hemorrhage leading to fetal demise. Fortunately, timely interventions saved the mother's life.

Laparoscopic sleeve gastrectomy: review of 500 cases in single surgeon Australian practice

Reported results and techniques of laparoscopic sleeve gastrectomy (LSG) are variable. Our objective was to assess results of weight loss, complications and reflux in a large consecutive series of LSG, describing technical detail which contributed to outcomes. Retrospective review of prospectively collected data of 500 consecutive patients undergoing LSG. Patient demographics, weight loss, complications and functional outcomes were analysed and operative technique described. Five hundred patients underwent LSG over 3 years (37 revisional). Mean (range) preoperative body mass index was 45 kg/m(2) (35-76 kg/m(2) ). Mean follow-up and length of hospital stay were 14 months (1-34) and 3.8 days (3-12), respectively. All-cause 30-day readmission rate 1.2%. Mean excess weight loss (interquartile range, available patient data) was 43% (22-65%, 423 patients), 58% (45-70%, 352 patients), 76% (52-84%, 258 patients), 71% (51-87%, 102 patients) and 73% (55-86%, 13 patients) at 3, 6, 12, 24, 36 months, respectively. There was no mortality. Intraoperative complications occurred in two (0.4%) - splenic bleeding; bougie related oesophageal injury. Early surgical complications in four (1.2%) patients (one staple line leak and three post-operative bleeds). Other early complications occurred in three (0.6%) patients (one pseudomembranous colitis; one central line sepsis; one portal venous thrombosis) and late in four (0.8%) patients (three port-site incisional hernias; mid-sleeve stricture requiring endoscopic dilatation). Gastro-oesophageal reflux symptoms decreased from 45 to 6%. With attention to detail, LSG can lead to good excess weight loss with minimal complications. Tenants to success include repair of hiatal laxity, generous width at angula incisura and complete resection of posterior fundus.

Contrast-enhanced Ultrasound for Detection of Traumatic Splenic Bleeding in a Canine Model During Hemorrhagic Shock and Resuscitation

Background Contrast-enhanced ultrasound (CEUS) is a highly specific and sensitive method for the detection of abdominal injury. We assessed the value of CEUS for real-time monitoring of splenic trauma and detection of bleeding in a canine model of splenic injury during hemorrhagic shock and resuscitation. Methods Forty Grades III and IV traumatic splenic lesions were created in 15 mongrel dogs. Hemorrhagic shock was induced by exsanguination via the left femoral artery. Animals in shock were then resuscitated with 6% hydroxyethyl starch. CEUS was performed continuously to investigate the imaging characteristics of splenic trauma and to monitor changes in bleeding. Results Prior to induction of hemorrhagic shock, CEUS revealed active bleeding in 36 of 40 traumatic lesions (90.0%), either as contrast medium extravasation or pooling, both in the spleen and outside the capsule. During the shock period, no traumatic lesion had active bleeding. CEUS revealed that tiny branches of splenic arteries decreased in number and became thinner. The traumatic lesions appeared as nonenhanced areas with poorly defined boundaries. After fluid resuscitation, rebleeding occurred in 30 traumatic lesions, and 28 (93.3%) of these were detectable by CEUS. Conclusions CEUS allowed real-time monitoring of splenic trauma and detection of bleeding and rebleeding in hemodynamically unstable dogs, prior to and after fluid resuscitation. This suggests that CEUS might be used in clinical intensive care for patients with traumatic hemorrhagic shock.

Autoimmune pancreatitis complicated by spontaneous subcapsular splenic haemorrhage.

Autoimmune pancreatitis is a rare but increasingly recognised condition with unique clinical, immunological and histological features. We report the first case of autoimmune pancreatitis associated with spontaneous splenic haemorrhage.A 75-year-old man presented with severe epigastric pain radiating to the back associated with nausea and vomiting. A CT-scan of his abdomen showed a large pseudocyst within the pancreatic tail as well as a subcapsular splenic haemorrhage. His IgG4 levels were elevated and clinical history and investigations were consistent with severe acute pancreatitis, but were negative for other known causes of pancreatic disease. The patient was started on steroid therapy and improved dramatically clinically, immunologically and radiologically thus confirming the diagnosis of autoimmune pancreatitis. His splenic haemorrhage was managed conservatively in view of his haemodynamic stablity and eventually self-resolved.Autoimmune pancreatitis should not be overlooked in cases of acute pancreatitis without other obvious etiology. Furthermore, superimposed splenic haemorrhage is a rare but important complication of autoimmune pancreatitis.

Cocaine-associated hemoperitoneum following atraumatic splenic rupture: a case report and literature review

IntroductionSplenic hematoma or rupture of the spleen is rare in the absence of trauma. This case report with a brief review of the literature is intended to raise awareness of splenic bleeding as an etiology of abdominal pain; it highlights the importance of a detailed social history.Presentation of caseThis report of an otherwise healthy 42-year old man details hemoperitoneum with splenic rupture as a cause for hemorrhage following cocaine use. The patient was managed non-operatively in the surgical intensive care unit. He did not require transfusion and was discharged home on hospital day four with close follow-up.DiscussionWhile splenic pathology associated with cocaine use has been described, this case illustrates a novel report of cocaine-associated splenic hemorrhage. A plausible mechanism is transient vasospasm with subsequent bleeding into the infarcted area.ConclusionAlthough uncommon, atraumatic splenic rupture should be recognized early because it is potentially fatal. This case is the first to describe hemoperitoneum of splenic etiology following cocaine use.

Laparoscopic nephrectomy in dogs: An initial experience of 16 experimental procedures

Left laparoscopic nephrectomy was performed in 16 dogs to describe the surgical techniques and initial experiences associated with operation time and surgery complications. The renal vein and artery were occluded by three ligating clips, respectively, and the ureter was sectioned after ligation with ligating clips at the level of the iliac vessels. A morcellation technique was used to remove the kidney from the abdominal cavity after placing it into a specimen retrieval bag. Total operation time and time spent for each different surgical stage in the first five operations were compared with those in the last five of the 16 operations.The factors that affected the differences of total operation time were examined, including sex, bodyweight, number of operations, incision length, and surgical stages. Six intra-operative complications occurred including splenic hemorrhage (3 cases), torn specimen retrieval bag during kidney morcellation (1 case), and subcutaneous emphysema (2 cases). Surgical time for laparoscopic nephrectomy was affected primarily by the time spent for renal vascular pedicle section and could be decreased as the number of cases increased. Thus, laparoscopic nephrectomy using ligating clips and morcellation for kidney removal could be considered where nephrectomy is indicated in dogs.