Traumatic spleen rupture diagnosed during postmortem dissection: A STROBE-compliant retrospective study

Atypically Taut Superior Polar Splenic Artery Discovered in a Human Cadaver

The splenic artery is the largest branch of the celiac trunk and frequently presents with anatomical variability. These variations relate to its origin, trajectory, location relative to the pancreas, terminal branching pattern, and the potential presence of polar arteries. Knowledge of the splenic artery's variability may inform gastrointestinal surgeons as they plan and execute surgical interventions, resulting in improved success rates while minimizing both operative complications and procedural time. The case presentation of a splenic artery dissected from an elderly male cadaver initially demonstrated normal anatomical arrangement. The artery branched off the celiac trunk of the abdominal aorta and followed a tortuous suprapancreatic route to split into two lobar arteries terminating in the spleen. However, upon closer inspection, a superior polar splenic artery was uncovered with two unique characteristics. Firstly, the presented polar artery lacked branching gastric arteries, a rare variation with a prevalence of only 3.27%. Secondly, the distance between the origin of the superior polar splenic artery and the splenic hilum was greater than what is often reported in clinical literature. While similar previous case reports have observed arterial origins of greater distance, these have often been accompanied by a compensatory arterial length. Interestingly, the case presented in this report contained a superior polar splenic artery with an arterial length shorter than its distance to the splenic hilum, resulting in an atypically taut vessel. This bears clinical importance, as this arterial presentation may be susceptible to a surgical rupture if neglected. By including this anatomical variation in the expanding library of splenic artery variations, surgeons and their collaborative healthcare teams may broaden their understanding of splenic artery anatomy as they conceptualize new techniques for pancreatomy and splenectomy procedures that consider arterial variations while minimizing surgical complications, operative time, and patient blood loss.

An unusual case of a traumatic splenic rupture masquerading as myocardial ischemia: a case report

Background

The spleen is one of the most frequently injured abdominal organs during trauma, which can result in intraperitoneal bleeding of life-threatening magnitude. Although splenic injury secondary to trivial trauma comprises a minor fraction of abdominal injuries, undiagnosed or delayed diagnosis may result in a complicated clinical course.

Case presentation

One such event is presented here, wherein a late diagnosis of an advanced grade splenic injury following a trivial trauma initially presented in disguise as acute myocardial ischaemia in a previously healthy South Asian woman in her late 30s. Emergency laparotomy and splenectomy were performed with simultaneous massive transfusion for a 3.5-L blood loss. She subsequently had an uncomplicated clinical course with regular surgical follow-up.

Conclusion

Splenic injuries might present with ambiguous symptoms such as atypical chest pain and shoulder pain, necessitating attending clinicians to have a high degree of suspicion, especially in busy units such as the emergency department (ED).

Changes to the myocardial enzyme spectrum in patients with different degrees of spleen injury and their clinical value

To investigate the changes to the myocardial enzyme profile and its clinical value in patients with different degrees of spleen injury. Of all patients who underwent total splenectomy due to trauma-induced spleen injury from January 2019 to January 2022 were selected, 70 patients with grade III and IV spleen injuries were selected as the experimental group. In addition, 70 patients with grade I and II were selected as control group 1, and another 70 patients as control group 2. The levels of creatine kinase (CK), creatine kinase isoenzyme (CK-MB), lactate dehydrogenase (LDH) in the 3 groups were detected before (T0) and on the 1st day (T1) after surgery, on the 3rd day (T2) and on the 7th day (T3) after surgery, and on the 14th day (T4) after surgery, respectively, to analyze the relationship with the severity of spleen injury. The spleen injury experimental group, control group 1, and control group 2 were all cured and discharged after corresponding treatment, and there was no myocardial infarction within 3 months of hospitalization and discharge follow-up. The experimental group had higher CK, CK-MB, and LDH than control group 1 and control group 2 at the same time point from T0 to T4 (P<.05); the CK and CK-MB of control group 1 were higher than those of control group 2 at the same time points from T0 to T4 (P < .05), the LDH at points T0 to T2 was higher than that of control group 2 (P < .05), and the LDH was lower at points T3 and T4. Compared with T0 in the same group, CK, CK-MB, and LDH at T1 to T4 in the 3 groups were all lower than those at T0 (P < .05). The early peripheral blood myocardial enzyme spectrum of patients with different degrees of spleen injury is increased, and the increase of myocardial enzyme spectrum is positively correlated with the severity of spleen injury, suggesting that patients with traumatic spleen injury may have myocardial damage in the early stage, and should be treated as soon as possible.

Porcine spleen as a model organ for blunt injury impact tests: An experimental and histological study

The spleen is a large and highly vascularized secondary lymphatic organ. Spleen injuries are among the most frequent trauma-related injuries in the abdominal region. The aims of the study were to assess the volume fractions of the main splenic tissue components (red pulp, white pulp, trabeculae and reticular fibres) and to determine the severity of splenic injury due to the experimental impact test. Porcine spleens (n = 17) were compressed by 6.22 kg wooden plate using a drop tower technique from three impact heights (50, 100 and 150 mm corresponding to velocities 0.79, 1.24 and 1.58 m/s). The pressure was measured via catheters placed in the splenic vein. The impact velocity was measured using lasers. The severity of induced injuries was analysed on the macroscopic level. The volume fractions of splenic components were assessed microscopically using stereology. The volume fraction of the red pulp was 76.4%, white pulp 21.3% and trabeculae 2.7% respectively. All impact tests, even with the low impact velocities, led to injuries that occurred mostly in the dorsal extremity of the spleen, and were accompanied by bleeding, capsule rupture and parenchyma crushing. Higher impact height (impact velocity and impact energy) caused more severe injury. Porcine spleen had the same volume fraction of tissue components as human spleen, therefore we concluded that the porcine spleen was a suitable organ model for mechanical experiments. Based on our observations, regions around hilum and the diaphragmatic surface of the dorsal extremity, that contained fissures and notches, were the most prone to injury and required considerable attention during splenic examination after injury. The primary mechanical data are now available for the researchers focused on the splenic trauma modelling.