Splenic Rupture Research Articles

S3759 Why Rare Pathology Should Never Go Overlooked: A Case Report of Splenic Rupture

S3759 Why Rare Pathology Should Never Go Overlooked: A Case Report of Splenic Rupture

S3922 A Rare Occurrence: Spontaneous Splenic Rupture in the Absence of Trauma or Disease

S3922 A Rare Occurrence: Spontaneous Splenic Rupture in the Absence of Trauma or Disease

Impact of Splenic Ischemic Preconditioning on Splenic Injury Induced by Hepatic Ischemia/Reperfusion in Albino Rats

Impact of Splenic Ischemic Preconditioning on Splenic Injury Induced by Hepatic Ischemia/Reperfusion in Albino Rats

Expression of Anti- Apoptotic Gene ( BARF1) and Immunomodulatory Gene (BCRF1) For Epstein Barr Virus in Chronic Active EBV Patients

Epstein Barr virus (EBV) is a herpes virus with double-stranded DNA enclosed by proteins. The envelope of the virus has glycoproteins, which are important for attachment and entry into the host cells (B cells and epithelial cells). EBV targets B cells by utilizing their molecular machinery to replicate the viral genome. The virus causes B cells to differentiate into memory B cells, which then can move into the circulatory system, or become latent until a trigger causes reactivation. The transmission of the Epstein Barr virus occurs in several ways, such as deep kissing or food-sharing. Increased levels of viral DNA are found in salivary secretions after the initial infection. Children can be infected after eating food that has already been chewed by an EBV infected individual. The transmission has occurred through stem cell and organ transplantation, as well as blood transfusion. EBV has several associated complications, One dangerous complication is splenic rupture due to infectious mononucleosis. Aim of the Study: To Estimation the immunemodulatory and Oncogenes for Epstein Barr Virus Associated with Viral Tumorigenesis in Chronic Active EBV Patients By Detection of EBV IgG in all samples , Estimation the expression of antiapoptotic gene ( BARF1) and immunomodulatory gene (BCRF1). Result: The study showed there are high significant between the patient group with different inflammation disease in addition infected with virus compare with have not disease When detection genetically about the virus in sample of infected by EBV the presence of genes has been diagnosed BARF1 and BCRF1 in patient's group.

Laparoscopic surgery: An effective alternative for managing severe blunt splenic injuries in patients who are ineligible for transcatheter arterial embolization

BackgroundTranscatheter arterial embolization (TAE) is an effective alternative to nonoperative management (NOM) to improve the spleen salvage rate for patients with blunt splenic injuries (BSIs), but it is not always available at some institutions. Moreover, laparoscopy has also been used to diagnose and treat trauma, including BSIs. MethodsWe present our 11-year experience in performing laparoscopic surgery for spleen salvage in patients with severe BSIs when TAE is infeasible. The outcomes of laparoscopic surgery or TAE for spleen salvage in hemodynamically stable patients with severe BSIs were compared. ResultsFifty-six patients underwent interventions for severe BSIs during this period. Twenty patients underwent laparoscopic surgery, and 36 underwent TAE. There were no significant differences in demographics, preoperative conditions, or clinical characteristics (all p > 0.05). In the laparoscopic surgery group, 15 patients (75%) underwent laparoscopic splenorrhaphy for spleen salvage surgery, and five (25%) required splenectomy. No complications requiring intervention were observed in the laparoscopic surgery group, whereas three patients in the TAE group required a late splenectomy for splenic abscess. No significant differences were detected in the splenic preservation rate, complication rate, or length of hospital stay between the groups (all p > 0.05). ConclusionLaparoscopy is feasible and safe for managing hemodynamically stable patients with severe BSIs, and the outcomes are comparable to those of TAE. When TAE is infeasible, laparoscopy can be considered an alternative to increase the spleen salvage rate.

Contrast-enhanced Ultrasound as a Method of Splenic Injury Assessment

Abstract Splenic injuries are common in abdominal trauma, as the spleen is one of the most often harmed organs. The treatment of splenic injuries underwent major changes during the past decades, shifting from a surgical approach to nonoperative management. This change of the proceedings results from a constantly growing awareness of the spleen’s crucial hematological and immunological function and was possible owing to the advances in radiological techniques. In a setting of high-energy trauma in hemodynamically stable patients, computed tomography (CT) remains the gold standard. Where ultrasonography (US) is of major importance is in cases of unstable patients undergone high-energy trauma or in patients after low-energy trauma. Nevertheless, baseline US’s sensitivity is not sufficient to detect splenic traumatic injuries; hence, a new method was developed involving ultrasound contrast agents (UCAs), called contrast-enhanced ultrasound (CEUS). In a low-energy trauma setting, it facilitates the diagnosis of abdominal lesions with a sensitivity close to that of CT, without the disadvantages of the latter. In addition, CEUS can be used in the follow-up of abdominal traumatic injuries. The fact that CEUS preserves CT’s sensitivity while not carrying the risk of radiation-induced cancer makes it feasible for children and pregnant women. This review aims to discuss the technical aspects of CEUS, the limitations, and possibilities regarding this modality, present the appearance of both a healthy and injured spleen, and compare CEUS’s effectiveness to that of CT through an analysis of retrievable studies.

Incidental finding of intramural splenic heterotopy in the colon mimicking subepithelial neoplasm: a case report

AimThe aim of this case report is describe an unprecedented case with histological and immunohistochemical diagnosis of splenic heterotopy in the colon using material obtained by endoscopic ultrasound-guided biopsy.BackgroundSplenic heterotopia is a benign condition characterized by the implantation of splenic tissue in areas distant from its usual anatomical site, such as the peritoneum, omentum, mesentery, liver, pancreas, and subcutaneous tissue and, more rarely, in locations such as the colon and brain. It is generally associated with a history of splenic trauma or splenectomy and typically does not cause specific symptoms.Case presentationA 35-year-old white male patient who was healthy, with no history of trauma or splenectomy, but had a family history of colorectal neoplasia underwent colonoscopy for screening. The examination revealed a large bulge in the proximal descending colon, covered by normal-appearing mucosa. Endoscopic ultrasound-guided puncture was performed with a 22 gauge fine needle biopsy, and the histopathological and immunohistochemical analysis results were consistent with a heterotopic spleen.ConclusionsThis is the first report of a primary intramural colic splenosis case with histological and immunohistochemical diagnosis of splenic heterotopia in the colon, using material obtained by endoscopic ultrasound and ultrasound-guided biopsy.

Angioembolization in patients with blunt splenic trauma in Germany -guidelines vs. Reality a retrospective registry-based cohort study of the TraumaRegister DGU®.

Nonoperative management (NOM) for blunt splenic injuries (BSIs) is supported by both international and national guidelines in Germany, with high success rates even for severe organ injuries. Angioembolization (ANGIO) has been recommended for stabilizable patients with BSI requiring intervention since the 2016 German National Trauma Guideline. The objectives were to study treatment modalities in the adult BSI population according to different severity parameters including NOM, ANGIO and splenectomy in Germany. Between 2015 and 2020, a retrospective registry-based cohort study was performed on patients with BSIs with an Abbreviated Injury Score ≥ 2 in Germany using registry data from the TraumaRegister DGU® (TR DGU). This registry includes patients which were treated in a resuscitation room and spend more than 24-h in an intensive care unit or died in the resuscitation room. A total of 2,782 patients with BSIs were included in the analysis. ANGIO was used in 28 patients (1.0%). NOM was performed in 57.5% of all patients, predominantly those with less severe organ injuries measured by the American Association for the Surgery of Trauma Organ Injury Scale (AAST) ≤ 2. The splenectomy rate for patients with an AAST ≥ 3 was 58.5%, and the overall mortality associated with BSI was 15%. In this cohort splenic injuries AAST ≥ 3 were predominantly managed surgically and ANGIO was rarely used to augment NOM. Therefore, clinical reality deviates from guideline recommendations regarding the use of ANGIO and NOM. Local interdisciplinary treatment protocols might close that gap in the future.

Splenic Rupture During Pregnancy: A Misdiagnosed, Rare Obstetrical Emergency

Splenic Rupture During Pregnancy: A Misdiagnosed, Rare Obstetrical Emergency

ThP7.4 - Splenic trauma in the West of Scotland: a seven year analysis of management and outcomes

Abstract Aim To evaluate admission characteristics and management of traumatic splenic injuries in the region over a seven-year period and investigate differences in clinical outcomes. Methods Data was obtained from the Scottish Trauma Audit Group (STAG). Retrospective cohort analysis was performed of adult patients who sustained splenic injuries between 2015 and 2022 and received operative (OM), embolization (EM) or conservative management (CM) at a multiple-site single NHS trust in the West of Scotland. Primary outcome was all-cause inpatient mortality, secondary outcomes was length of stay (LOS). Results 129 patients were included. Majority of patients were male (73.6%, n=95). A third (34.1%) underwent OM (n=44), 4.7% underwent EM (n=6) and 61.2% (n=79) were managed conservatively. Median age was highest in the EM group at 61 years, versus 35 and 40 years in OM and CM groups (p=0.039). OM group patients had the highest median admission lactate (3.0) and median H+ ions (48.5) versus the CM group with a median lactate of 2.0 (p=0.050) and H+ of 45.9 (p=0.010). CM failed in 4.8% (n = 4) and required either OM or EM. Overall mortality was 3.9%, and exclusively observed in the CM group. Longest median LOS was observed in the EM group (17 days), versus 10 and 9 days in OM and CM groups (p=0.207). Conclusion Mortality from splenic injury in the region is low. Patients who were shocked on admission were more likely to be managed operatively. Few patients were managed with embolisation, but this cohort had a significantly longer LOS.

Impact of laparoscopic ultrasound during PIPAC directed treatment of unresectable peritoneal metastasis.

Laparoscopic ultrasound (LUS) combines both laparoscopy and ultrasound imaging of the peritoneum liver and retroperitoneum. LUS has not been described in treatments with pressurized intraperitoneal aerosol chemotherapy (PIPAC). We present our experience with LUS in patients undergoing PIPAC. Retrospective study of LUS findings from the prospective PIPAC-OPC2 trial. Main outcome was changes in overall treatment strategy due to LUS findings. PIPAC-OPC2 included 143 patients of which 33 patients were treated with electrostatic precipitation PIPAC. Nine patients were excluded due to primary non-access. During PIPAC 1, LUS was performed in 112 of 134 (84 %) PIPAC procedures and changed overall treatment strategy in one patient due to detection of multiple liver metastases unseen by baseline CT. During PIPAC 2 and 3 LUS was performed in 59 of 104 (57 %) and 42 of 78 (54 %) PIPAC procedures, respectively. Throughout PIPAC 1-3, LUS also detected pathological lymph nodes in 16 patients, and focal liver lesions in another four patients of uncertain origin. No further examinations were performed in these patients, and the overall treatment strategy was not changed according to the PIPAC-OPC2 protocol. One patient had a splenic capsule rupture related to the LUS itself. This was managed conservatively. LUS may be safely performed during PIPAC. However, LUS has limited clinical impact in patients scheduled for PIPAC, and cannot be recommended as a routine procedure when performing PIPAC.

Feasibility and value of modular splenic hilar lymphadenectomy technique in laparoscopic total gastrectomy: a retrospective-controlled research.

This study aims to investigate the feasibility and value of modular splenic hilar lymphadenectomy (MSHL) in LTG for advanced PGC located at the greater curvature. A retrospective-controlled research included 54 patients diagnosed with advanced PGC located at the greater curvature who underwent LTG combined with spleen-preserving hilar lymphadenectomy between January 2020 and December 2022 at the same treatment center. A total of 20 patients underwent classic splenic hilar lymphadenectomy (CSHL) using a medial approach (classic group), while 34 patients underwent MSHL (modular group). We summarized the technical points, caveats, and critical steps of the MSHL technique and observed and compared clinical indexes between the two groups. All operations were successful without conversion to laparotomy. The mean operation time, mean splenic hilar lymph node dissection (LND) time, median intraoperative blood loss, and blood loss from splenic hilar LND were all significantly lower in the modular group than in the classic group (p < 0.05). The amount of NO.10 lymph nodes (LNs) was significantly higher in the modular group than in the classic group (p < 0.05). In the classic group, one patient experienced intraoperative splenic vein injury, and one experienced spleen laceration, whereas no intraoperative complications occurred in the modular group. The median postoperative feeding time, exhaust time, defecation time, and postoperative stay were all significantly lower in the modular group compared to the classic group (p < 0.05). In the modular group, one patient experienced Clavien-Dindo I complication and one Clavien-Dindo II complication, while in the classic group, one patient experienced Clavien-Dindo II complication and one Clavien-Dindo IIIa complication. There were no patient was re-hospitalized within 30days after surgery. The modular splenic hilar LND technique can simplify complicated surgical procedures in SPSHL and reduce the risk of intraoperative bleeding and collateral damage.

Survival and complications in splenic trauma: surgical versus non-surgical outcomes

Survival and complications in splenic trauma: surgical versus non-surgical outcomes

Diagnostic criteria for optimizing treatment tactics for children with traumatic splenic ruptures

BACKGROUND: Damage to the spleen is the leading cause of abdominal trauma in children. This often becomes the main indication for splenectomy. This article addresses concerns on the safety of conservative treatment of these injuries in children. Most studies have found that asplenization results in the complete loss of the immunological and hematological functions of the spleen. Thus, spleen-preserving surgeries are crucial to prevent post-splenectomy hyposplenism and associated life-threatening complications. AIM: This study aimed to develop a mathematical model using logistic regression to determine aggregate variables associated with the possibility of surgical treatment and identify safe shock index parameters for the conservative treatment of traumatic splenic ruptures in children. MATERIALS AND METHODS: This prospective study included 91 patients with traumatic splenic rupture: 80 (87.9%) children received conservative treatment and 11 (12.1%) underwent surgical treatment. The age of the children was 11 (8; 13) years; there were 3.3 times more boys (70 versus 21). To assess the need for surgical treatment, an analysis of categorical variables was conducted using a mathematical model using logistic regression. RESULTS: Increased shock index (β = −0.264 ± 0.083; t(86) = −3.191; p = 0.002) and the need for blood transfusion (β = 0.464 ± 0.089; t(86) = 5.218; p = 0.001) were cumulative factors associated with a high possibility of surgical treatment of splenic ruptures in children. With the combination of parameters of increased shock index and blood transfusion for surgical treatment, moderate sensitivity was determined at 85.7% (95% CI: 52.1–99.6; p = 0.001) and a positive predictive value at 75% (95% CI: 34.9–96.8). In the absence of these factors, the probability of conservative treatment of children with splenic ruptures reached 100% (specificity: 97.5%; 95% CI: 91.1–99.7; p = 0.001). When summarizing the identified parameters, the area under the curve was 0.941 ± 0.026 (95% CI: 0.872–0.980), and the assessment of the model’s suitability showed a positive test (χ2 = 32.7; p = 0.264). In nonoperative treatment, the frequency of identified cumulative factors was 2.5% (n = 2). Safe shock index parameters for successful conservative treatment of splenic ruptures in children have been determined: SIPA 1.1 (age up to 6 years), 0.85 (7–12 years), and 0.83 (over 13 years). CONCLUSIONS: An increased shock index and the need for blood transfusion are combined factors that determine the high probability of surgical treatment for traumatic ruptures of the spleen in children. In nonoperative treatment, the frequency of identified cumulative factors was 2.5%, which indicates a strong argument for justifying the safety of conservative therapy.

Integration of proteomics and metabolomics analysis investigate mechanism of As-induced immune injury in rat spleen

Arsenic (As) is a widespread metalloid and human carcinogen found in the natural environment, and multiple toxic effects have been shown to be associated with As exposure. As can be accumulated in the spleen, the largest peripheral lymphatic organ, and long-term exposure to As can lead to splenic injury. In this study, a Sprague-Dawley (SD) rat model of As-poisoned was established, aiming to explore the molecular mechanism of As-induced immune injury through the combined analysis of proteomics and metabolomics of rats’ spleen. After feeding the rats with As diet (50 mg/kg) for 90 days, the spleen tissue of the rats in the As-poisoned group was damaged, the level of As was significantly higher than that of the control group (P < 0.001), and the level of inflammatory cytokine interleukin-6 (IL-6) was decreased (P < 0.01). Proteomics and metabolomics results showed that a total of 134 differentially expressed proteins (DEPs) (P < 0.05 and fold change > 1.2) and 182 differentially expressed metabolites (DEMs) (VIP >1 and P < 0.05) were identified in the spleens of the As poisoned group compared to the control group (As/Ctrl). The proteomic results highlight the role of hypoxia-inducible factors (HIF), natural killer cell mediated cytotoxicity, and ribosomes. The major pathways of metabolic disruption included arachidonic acid (AA) metabolism, glycerophospholipid metabolism and folate single-carbon pool. The integrated analysis of these two omics suggested that Hmox1, Stat3, arachidonic acid, phosphatidylcholine and leukotriene B4 may play key roles in the mechanism of immune injury to the spleen by As exposure. The results indicate that As exposure can cause spleen damage in rats. Through proteomic and metabolomic analysis, the key proteins and metabolites and their associated mechanisms were obtained, which provided a basis for further understanding of the molecular mechanism of spleen immune damage caused by As exposure.

Splenic rupture in dairy cattle: Report of 24 cases.

Splenic rupture in cattle is scarcely described in the literature. The aim of this work was to report the occurrence of splenic rupture in cattle in southern Brazil as well as to describe the causes of the condition. Between 2013 and 2022, 24 of the 1769 bovine necropsies performed in southern Brazil were due to splenic rupture, accounting for 1.36% of the diagnoses. Animals died due to hemoperitoneum caused by a rupture in the splenic capsule, typically associated with marked splenomegaly and a large hematoma between the capsule and the parenchyma. Clinical signs were described in a subset of cases (11 of 24 cases, 46%) and included apathy, abdominal pain, mucosal pallor, tachycardia, and respiratory distress. However, the majority (13 of 24 cases, 54%) presented as sudden death. The underlying cause of splenic rupture was established as follows: 16 cases (67%) secondary to babesiosis, 4 cases (17%) due to lymphoma, 1 case (4%) due to a thrombus, 1 case (4%) due to external trauma, 1 case due to a ruptured nodular lymphoid hyperplasia (4%), and 1 case of undetermined cause (4%). Hypovolemic shock caused by splenic rupture is an important cause of death of dairy cattle, and babesiosis and bovine leukemia virus-associated lymphoma are among the most common etiologic diagnoses (84% of cases). The description of the causes of this condition is important to clarify the pathogenesis and occurrence of splenic rupture in dairy cattle.

Splenic subcapsular hematoma following endoscopic retrograde cholangiopancreatography: A case report and review of literature

BACKGROUND Splenic injury following endoscopic retrograde cholangiopancreatography (ERCP) is a rare complication. The literature contains around 30 articles reporting various degrees of splenic injuries resulting from ERCP since the first report of splenic rupture after ERCP in 1989. CASE SUMMARY This report describes a case of splenic hematoma and stent displacement in a 69-year-old male patient who developed these conditions 7 days after undergoing ERCP and stenting. The patient had bile duct stenosis caused by a malignant tumor that was obstructing the bile duct. The diagnosis was confirmed by epigastric computed tomography and magnetic resonance cholangiopancreatography. The patient was successfully treated with percutaneous transhepatic cholangial drainage, endoscopic pyloric stent placement, and conservative management. The causes of splenic injury following ERCP are discussed. CONCLUSION ERCP has the potential to cause splenic injury. If a patient experiences symptoms such as abdominal pain, decreased blood pressure, and altered hematology after the procedure, it's important to be thoroughly investigated for postoperative bleeding and splenic injury.

Correction to: Neonatal haemoperitoneum due to splenic rupture: a case report

Correction to: Neonatal haemoperitoneum due to splenic rupture: a case report

Intraoperative surgical complications of open surgery for congenital diaphragmatic hernia: a multicenter, observational study in Japan.

This study aimed to clarify surgical complications associated with open surgery for congenital diaphragmatic hernia (CDH). We performed an exploratory data analysis of the clinical characteristics of surgical complications of neonates with CDH who underwent laparotomy or thoracotomy between 2006 and 2021. Data of these patients were obtained from the database of the Japanese CDH Study Group. Among 1,111 neonates with left or right CDH, 852 underwent open surgery (laparotomy or thoracotomy). Of these 852 neonates, 51 had the following surgical complications: organ injury (n = 48; 6% of open surgeries); circulatory failure caused by changes in the organ location (n = 2); and skin burns (n = 1). Injured organs included the spleen (n = 30; 62% of organ injuries), liver (n = 7), lungs (n = 4), intestine (n = 4), adrenal gland (n = 2), and thoracic wall (n = 2). Fourteen of the patients who experienced organ injury required a blood transfusion (2% of open surgeries). The adjusted odds ratio of splenic injury for patients with non-direct closure of the diaphragm was 2.2 (95% confidence interval, 1.1-4.9). Of the patients who underwent open surgery for CDH, 2% experienced organ injury that required a blood transfusion. Non-direct closure of the diaphragmatic defect was a risk factor for splenic injury.

Splenic Salvage Following Iatrogenic Splenic Artery Injury Post-gastrectomy

Splenic Salvage Following Iatrogenic Splenic Artery Injury Post-gastrectomy