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Schultz BL, Bookbinder LC, Claffey EF, Luedke LK, Delvescovo B, Fubini SL, Radcliffe RM. Treatment and outcomes of two pigs treated for hemoabdomen secondary to splenic disease. Vet Surg 2022; 51:1206-1214. [PMID: 35857027 DOI: 10.1111/vsu.13858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 05/26/2022] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To report the management and outcomes of two pigs undergoing emergency surgery for hemoabdomen secondary to splenic disease. STUDY DESIGN Case report. ANIMAL Two adult pigs with hemoabdomen and suspected splenic pathology. METHODS Pigs were admitted for several clinical signs including lethargy, inappetence, vomiting, abdominal distention, hypothermia, and tachycardia. Abdominal ultrasound and abdominocentesis led to a diagnosis of hemoabdomen secondary to splenic disease. RESULTS The spleen was confirmed as the source of hemorrhage during midline exploratory celiotomy in both pigs. Splenic rupture resulted from splenic vein thrombosis in one pig and splenic torsion in the other. Complications included intraoperative hemorrhage and intraabdominal adhesion formation. Four years following splenectomy, one pig was euthanized because of widespread small intestinal adhesions causing luminal obstruction, while the other pig was euthanized following a diagnosis of chronic myeloid leukemia. CONCLUSIONS A ventral midline celiotomy provided adequate exposure for splenectomy. The procedure allowed resolution of signs in both pigs. Splenic pathology, such as vessel thrombosis or torsion, may result in splenic rupture and should be considered as a differential in pigs with hemoabdomen.
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Affiliation(s)
- Brooke L Schultz
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Lauren C Bookbinder
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Elaine F Claffey
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Lauren K Luedke
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Barbara Delvescovo
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Susan L Fubini
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
| | - Rolfe M Radcliffe
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA
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Lin JL, Lin C, Wang HL, Wu SJ, Tang Y, Yang CS, Luo JW, Chi W, Fang ZT. Splenic Artery Embolization and Splenectomy for Spontaneous Rupture of Splenic Hemangioma and Its Imaging Features. Front Cardiovasc Med 2022; 9:925711. [PMID: 35722106 PMCID: PMC9205459 DOI: 10.3389/fcvm.2022.925711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/17/2022] [Indexed: 12/02/2022] Open
Abstract
Background Spontaneous splenic rupture (SSR) is a rare, often life-threatening, acute abdominal injury that requires immediate diagnosis and early treatment. SSR is mainly treated surgically or conservatively. A few cases of interventional embolization for SSRs have been reported. Case Presentation A 30-year-old male patient complaining mainly of left upper abdominal pain underwent emergency abdominal computed tomography (CT) and showed enlargement of the spleen with a massive mixed-density shadow approximately 10.0 × 8.0 × 12.5 cm in size. The boundary was unclear and showed obvious progressive enhancement. Considering the intrasplenic tumor lesions with rupture and hemorrhage, the possibility of vascular tumors was high, with intraperitoneal blood and fluid accumulation. Digital subtraction angiography of the splenic arteriography and embolization of the ruptured splenic artery branches were performed. Postoperative hemoglobin progressively decreased, inflammatory indicators, such as white blood cell counts, procalcitonin (PCT), and C-reactive protein (CRP) were significantly increased, and 2 days after embolization, the patient developed severe hypoxemia, shock, pulmonary edema, and acute respiratory distress syndrome. CT re-examination 9 days after embolization showed reduced lesion absorption. After stabilization of the condition, splenectomy was performed, and postoperative platelet count increase, anticoagulant improvement, and discharge were observed. Postoperative pathological examination revealed extensive hemorrhage and necrosis, vascular tissue with abnormal hyperplasia in the surrounding area, vascular tissue in the bleeding area and outer wall (elastic fiber staining +), and local myofibroblast hyperplasia. Immunohistochemistry showed actin (SM +) and Ki67 (10% +). Conclusion SSR caused by splenic hemangioma is rare, and the choice between surgical treatment or splenic artery embolization remains dependent on the patient's hemodynamic stability and imaging findings.
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Affiliation(s)
- Jia-Li Lin
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Can Lin
- Department of Radiology, Fuzhou Second Hospital, Fuzhou, China
| | - Han-Lu Wang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Shao-Jie Wu
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, China
| | - Yi Tang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, China
| | - Chang Shun Yang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Jie-Wei Luo
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- *Correspondence: Jie-Wei Luo
| | - Wu Chi
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Emergency Department, Fujian Provincial Hospital, Fuzhou, China
- Wu Chi
| | - Zhu-Ting Fang
- Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
- Department of Interventional Radiology, Fujian Provincial Hospital, Fuzhou, China
- Zhu-Ting Fang
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Senthilkumaran S, Vijayakumar P, Savania R, Vaiyapuri R, Elangovan N, Patel K, Trim SA, Thirumalaikolundusubramanian P, Vaiyapuri S. Splenic rupture and subsequent splenectomy in a young healthy victim following Russell's viper bite. Toxicon 2021; 204:9-13. [PMID: 34751135 DOI: 10.1016/j.toxicon.2021.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/09/2021] [Accepted: 10/25/2021] [Indexed: 12/01/2022]
Abstract
Splenic rupture and/or splenectomy is/are not uncommon in clinical arena. Here we present this case of extensive haemorrhage-induced splenic rupture which resulted in splenectomy in a young healthy male (who did not have any previous medical conditions) following a Russell's viper bite. He developed upper abdominal and shoulder pain on his left side along with hypotension and reduced level of haemoglobin on the third day following bite despite antivenom treatment. Following confirmation of splenic rupture and haemoperitoneum by ultrasound and computed tomography scans, an emergency splenectomy was performed using laparotomy. Although Russell's viper bites are known to induce bleeding complications, splenic rupture due to haemorrhage in spleen has not been previously reported. Russell's viper venom toxins such as metalloproteases, serine proteases and phospholipase A2 might have affected the vascular permeability resulting in excessive bleeding and increased pressure in the spleen leading to rupture. Further investigations are required to underpin the impact of snake venom toxins on the architecture and functions of spleen. However, the clinicians who treat snakebites should be aware of this type of rare complications so as to provide appropriate management for such victims.
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Affiliation(s)
| | | | - Ravi Savania
- School of Pharmacy, University of Reading, Reading, UK
| | | | - Namasivayam Elangovan
- Department of Biotechnology, School of Biosciences, Periyar University, Salem, Tamil Nadu, India
| | - Ketan Patel
- School of Biological Sciences, University of Reading, Reading, UK
| | | | - Ponniah Thirumalaikolundusubramanian
- Trichy SRM Medical College Hospital & Research Centre, Trichy, Tamil Nadu, India; The Tamil Nadu Dr MGR Medical University, Chennai, Tamil Nadu, India
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Vemulakonda SHP, S SS, Jain A, Reddy A, Nelamangala Ramakrishnaiah VP. A Rare Case of Spontaneous Splenic Rupture as the Index Presentation of Chronic Myeloid Leukemia. Cureus 2021; 13:e19647. [PMID: 34976446 PMCID: PMC8678100 DOI: 10.7759/cureus.19647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 11/08/2022] Open
Abstract
Splenic injury is usually caused by blunt trauma to the abdomen. Very rarely, spontaneous rupture can occur in patients with splenomegaly due to various underlying pathological conditions such as hematological, neoplastic, inflammatory, and infectious diseases. Here, we report the case of a 48-year-old gentleman who presented to the emergency department with sudden-onset pain in the abdomen and hypotension. Blood investigation revealed anemia and leukocytosis with blast cells on peripheral smear, suggestive of chronic myeloid leukemia (CML) in the chronic phase. Contrast-enhanced computed tomography revealed splenomegaly with grade three splenic laceration and a subcapsular hematoma with hemoperitoneum. Because of persistent hemodynamic instability, despite resuscitation, he underwent emergency splenectomy. The postoperative period was uneventful. Bone marrow biopsy revealed CML in the chronic phase with World Health Organization grade I reticulin fibrosis. Subsequently, he was started on hydroxyurea and discharged for further follow-up with medical oncology.
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Case report of a spontaneous splenic rupture in a patient with chronic lymphocytic leukaemia treated by arterial splenic embolization. Int J Surg Case Rep 2021; 80:105607. [PMID: 33607368 PMCID: PMC7900328 DOI: 10.1016/j.ijscr.2021.01.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/21/2022] Open
Abstract
SSR is an atraumatic event in which the spleen is damaged producing internal haemorrhage in the abdominal cavity. Actually the treatment of SSR is either surgical or conservative. Only few cases of radiological intervention are published in the literature. Splenic arterial embolization is a safe treatment option that allows rapid stabilization of the patient while offering both the benefits of splenectomy and conservative treatment. We present our experience of a case of SSR in a patient with chronic lymphocytic leukaemia managed by emergency embolization and elective surgery.
Introduction and importance Spontaneous splenic rupture (SSR) is a rare phenomenon where the spleen ruptures without associated trauma. SSR can lead to an intra-abdominal haemorrhage and an acute abdomen that can be life threatening. Case presentation In this article, we present the case of an 81-year-old woman with chronic lymphocytic leukaemia who presented to the emergency department with severe abdominal pain. Clinical discussion In order to stabilize the patient, while awaiting elective surgery, we managed the rupture with splenic embolization and we reviewed the literature related to the treatments of SSR especially, by arterial splenic embolization. Conclusion Splenic embolization is a safe treatment option, that allows a rapid stabilization and has the advantage of both, splenectomy and conservative treatment.
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