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Odeh AM, Boumarah KA, Alsumaien WA, Al-Abbad MT, Al-Ali AH, Alammar ZA, Alsuqair H, Albeladi AM, Alsuwaigh A, Omrani A, Almuhanna MM, Busbaih Z, Al-Shaban HR, Aldhameen AA. A Huge Subcapsular Splenic Cyst Like Hematoma in Sickle Cell Anemia. Cureus 2022; 14:e22582. [PMID: 35371821 PMCID: PMC8958125 DOI: 10.7759/cureus.22582] [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: 02/24/2022] [Indexed: 11/25/2022] Open
Abstract
Nontraumatic splenic rupture and hematoma are rare in sickle cell disease. We present a case of a 22-year-old Saudi male with sickle cell disease. He presented to our hospital with a history of nontraumatic abdominal pain, hemodynamic instability, and abdominal tenderness, with a large mass extending to the umbilicus. A computed tomography (CT) examination showed splenomegaly and a spleen infarction. The patient was admitted to the intensive care unit (ICU) and stabilized. He was transferred to the regular ward and discharged against medical advice (DAMA). Later on, he presented again with persistent abdominal pain. He underwent splenectomy with cholecystectomy. The patient did well postoperatively and was discharged in good condition. While conservative management is common, operative management should be considered in patient with persistent pain. Splenic rupture has a high mortality rate.
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Fegan D. Splenic rupture. Clin Med (Lond) 2019; 19:188-189. [PMID: 30872308 PMCID: PMC6454373 DOI: 10.7861/clinmedicine.19-2-188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nachman D, Yehoshua L, Benov A, Glassberg E, Padova H. Splenic Trauma in the Israeli Defense Forces - Do Not Underestimate Minor Trauma. Mil Med 2018; 183:169-174. [PMID: 29635574 DOI: 10.1093/milmed/usx168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 12/23/2018] [Indexed: 11/14/2022] Open
Abstract
Background The spleen is the most commonly damaged abdominal organ following blunt abdominal trauma (BAT), usually involving a major injury mechanism. Several cases of splenic rupture caused by minor BAT in the Israeli Defense Forces (IDF) have recently occurred. This led us to explore the demographics and mechanisms of trauma resulting in splenic injury among IDF personnel. Methods All cases of splenic injury between 2007 and 2015 were pulled from the computerized patient records of the IDF. Data regarding patient demographics, injury mechanism, presenting symptoms, treatment, and outcomes were collected. Three independent physicians graded the injury mechanism as major or minor. Results Fifty-two cases of splenic injury were identified. Of them, 82.7% resulted from a blunt trauma, 9.6% occurred after a penetrating trauma and 7.7% occurred spontaneously. 37.2% of BAT were unanimously considered as minor. Patients who suffered minor trauma were more likely to experience delayed diagnosis (85.7% vs. 0% p < 0.0001) and had significantly less concomitant injuries (12.5% vs. 88.8% p < 0.0001). The presentation, treatment, and outcome of the patients were similar, regardless of the severity of trauma mechanism. Conclusion Our findings indicate that although minor BAT results from a milder traumatic mechanism, it is a significant cause of splenic injury among active duty personnel. We suggest that military physicians maintain a high level of suspicion while managing minor BAT cases.
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Affiliation(s)
- Dean Nachman
- Israel Defense Forces Medical Corps Surgeon General's Headquarters Military, POB 02149, Tel Hashomer, Ramat Gan, Military Postal Code 01215, Israel.,Institute for Research in Military Medicine, Hebrew University and IDF MC, POB 12272, Jerusalem 91120, Israel.,Internal Medicine A, Hadassah Medical Center, POB 12249, Jerusalem 91120, Israel
| | - Lior Yehoshua
- Israel Defense Forces Medical Corps Surgeon General's Headquarters Military, POB 02149, Tel Hashomer, Ramat Gan, Military Postal Code 01215, Israel
| | - Avi Benov
- Israel Defense Forces Medical Corps Surgeon General's Headquarters Military, POB 02149, Tel Hashomer, Ramat Gan, Military Postal Code 01215, Israel
| | - Elon Glassberg
- Israel Defense Forces Medical Corps Surgeon General's Headquarters Military, POB 02149, Tel Hashomer, Ramat Gan, Military Postal Code 01215, Israel
| | - Hagit Padova
- Israel Defense Forces Medical Corps Surgeon General's Headquarters Military, POB 02149, Tel Hashomer, Ramat Gan, Military Postal Code 01215, Israel
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Tunçyürek Ö, Tunçyürek P, Ertekin E, Gök M, Nevai EH, Döger FK, Özsunar Y. Pathological rupture of the normal spleen: Review with the literature. Int J Surg Case Rep 2016; 26:163-5. [PMID: 27497938 PMCID: PMC4975709 DOI: 10.1016/j.ijscr.2016.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/11/2016] [Accepted: 07/23/2016] [Indexed: 11/30/2022] Open
Abstract
Atraumatic spontaneous rupture of the spleen is an uncommon but fatal case. A healty spleen does not rupture without marked trauma. Although atraumatic rupture of the spleen is not prevalent, it has highly fatal outcomes without CT exam.
Introduction Atraumatic spontaneous rupture of the spleen is an uncommon but fatal condition that may coexist with other disease. Our case was presented with obvious CT findings of a spontaneous rupture of the spleen. Presentation of the case A 75-year-old woman admitted to the emergency service with abdominal pain. Although there was no evident splenomegaly in the abdominal CT examination, the patient was diagnosed with diffuse large B-cell lymphoma, and densities in harmony with the free air were detected in the spleen and the abdomen. Discussion It is clear that a healthy spleen does not rupture without marked trauma; hence, a doctor must carefully investigate the underlying pathology. Splenomegaly, the infiltration of the spleen and the capsule and consequently a splenic infarct and hemorrhage were set forth as the causes of the rupture of the spleen in lymphomas. However, our case had no splenomegaly or splenic involvement of lymphoma in the pathological examination. Even in the absence of splenomegaly, rupture may develop for such reasons as inflammation and embolism. Splenic infarcts are also in the developmental mechanism. Conclusion Although atraumatic rupture of the spleen is not prevalent, it is a case which must be considered in an acute abdominal pain as it has highly fatal outcomes without CT exam.
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Affiliation(s)
- Özüm Tunçyürek
- Adnan Menderes University School of Medicine Radiology Dep, Aydin, Turkey.
| | - Pars Tunçyürek
- Adnan Menderes University School of Medicine Surgery Dep, Aydin, Turkey
| | - Ersen Ertekin
- Adnan Menderes University School of Medicine Radiology Dep, Aydin, Turkey
| | - Mustafa Gök
- Adnan Menderes University School of Medicine Radiology Dep, Aydin, Turkey
| | - Emir Hüseyin Nevai
- Adnan Menderes University School of Medicine Radiology Dep, Aydin, Turkey
| | | | - Yelda Özsunar
- Adnan Menderes University School of Medicine Radiology Dep, Aydin, Turkey
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Kar S, Mallick A, Aung T. A rare cause of anaemia in an older patient with fractured neck of femur. J R Coll Physicians Edinb 2016; 46:18-20. [PMID: 27092364 DOI: 10.4997/jrcpe.2016.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- S Kar
- S Kar, Department of Elderly Medicine, Hull & East Yorkshire Hospitals, NHS Trust, Anlaby Road, Hull, HU3 2JZ, UK. Email
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Leiblein M, Ullrich D, Habbe N, Keese M, Marzi I, Lehnert M. Case report-delayed splenic rupture in combination with medial femoral neck fracture after low energy trauma. Development of hemorrhagic shock 5 days after hip prosthesis due to a rare cause. Trauma Case Rep 2016; 2:1-5. [PMID: 29942831 PMCID: PMC6011855 DOI: 10.1016/j.tcr.2016.01.001] [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: 01/11/2016] [Indexed: 11/30/2022] Open
Abstract
A 79 year old female patient was admitted to our emergency department with a fracture of the right medial femoral neck six days after a fall on her right side and a cemented hemiprosthesis was implanted. Five days later, she developed a hemorrhagic shock and was diagnosed with a delayed splenic rupture and the spleen was resected. Histopathological examination showed a delayed rupture of an otherwise normal spleen without signs of an underlying pathology. The outcome was fatal: In the postoperative course she developed pneumonia, three weeks later she succumbed due to multiple organ failure. Even careful reevaluation of the case did not provide any clues to expect an injury of the spleen according to trauma mechanism. This case shows that delayed splenic rupture of a normal spleen may occur even after a low energy trauma. Injury of the spleen should therefore always be considered, even with an uncharacteristic anamnesis. Physical examination after trauma should therefore always include a careful clinical evaluation. The clinical threshold for a FAST examination should be low. The coincidence of a femoral neck fracture and a splenic rupture after a low energy trauma has not been reported before.
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Affiliation(s)
- M Leiblein
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - D Ullrich
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - N Habbe
- Department of General and Visceral Surgery, Hospital of the Goethe University, 60590 Frankfurt am Main, Germany
| | - M Keese
- Department of Vascular and Endovascular Surgery, Hospital of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - I Marzi
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - M Lehnert
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Bourgeois SL, Fey J. Facial trauma evaluation leading to a diagnosis of delayed splenic rupture. J Oral Maxillofac Surg 2014; 72:1541-4. [PMID: 24746399 DOI: 10.1016/j.joms.2014.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 02/28/2014] [Accepted: 02/28/2014] [Indexed: 10/25/2022]
Abstract
A patient presented 48 hours after falling and sustaining facial fractures and was evaluated in an outpatient setting. The patient had been seen at 2 other hospitals, including a level I trauma center, and discharged home. While undergoing evaluation for his facial trauma, the patient became severely hypotensive. The patient was diagnosed with a delayed splenic rupture and underwent splenectomy.
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Affiliation(s)
- Sidney L Bourgeois
- Chief, Oral and Maxillofacial Surgery Service; Chief, Dental Service, Syracuse Veterans Affairs Medical Center, Syracuse, NY.
| | - John Fey
- Attending Surgeon, Department of Surgery, Syracuse Veterans Affairs Medical Center, Syracuse, NY
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Delayed splenic rupture: dating the sub-capsular hemorrhage as a useful task to evaluate causal relationships with trauma. Forensic Sci Int 2013; 234:64-71. [PMID: 24378304 DOI: 10.1016/j.forsciint.2013.10.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 10/13/2013] [Accepted: 10/28/2013] [Indexed: 11/21/2022]
Abstract
The aim of the paper was to perform a chronological assessment of the phenomenon of delayed rupture of the spleen, to assess the phenomenological order about the sub-capsular hematoma transformation to determine the causal relationship with trauma as hypothetical cause of death. 80 cases of blunt trauma with splenic capsular hematoma and subsequent rupture of the spleen were evaluated: 38 had an acute rupture of the spleen, 42 presented a break in days or weeks after the traumatic injury. Time between the traumatic event and delayed rupture of the spleen is within a range of time from one day to more than one month. Data recorded included age, sex, type of trauma, injury severity score, grade of splenic injury, associated intra-abdominal injuries, pathologic specimen evaluation. Immunohistochemical investigation of perisplenic hematoma or laceration was performed utilizing polyclonal antibodies anti-fibrinogen, CD61 and CD68, and showed structural chronological differences of sub-capsular hematoma. Expression of modification and organization of erythrocytes, fibrinogen, platelets and macrophages provides an informative picture of the progression of reparative phenomena associated with sub-capsular hematoma and subsequent delayed splenic rupture. Sub-capsular splenic hematoma dating, which we divided into 4 phases, is representing a task in both clinical practice and forensic pathology.
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Aubrey-Bassler FK, Sowers N. 613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review. BMC Emerg Med 2012; 12:11. [PMID: 22889306 PMCID: PMC3532171 DOI: 10.1186/1471-227x-12-11] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 07/28/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Rupture of the spleen in the absence of trauma or previously diagnosed disease is largely ignored in the emergency literature and is often not documented as such in journals from other fields. We have conducted a systematic review of the literature to highlight the surprisingly frequent occurrence of this phenomenon and to document the diversity of diseases that can present in this fashion. METHODS Systematic review of English and French language publications catalogued in Pubmed, Embase and CINAHL between 1950 and 2011. RESULTS We found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size) spleens in 35 cases and after minor trauma in 23 cases. Medications were implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its complications in 38 cases. The most common associated diseases were infectious (n = 143), haematologic (n = 84) and non-haematologic neoplasms (n = 48). Amyloidosis (n = 24), internal trauma such as cough or vomiting (n = 17) and rheumatologic diseases (n = 10) are less frequently reported. Colonoscopy (n = 87) was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n = 6), infarction (n = 6) and hamartomata (n = 5). Medications associated with rupture include anticoagulants (n = 21), thrombolytics (n = 13) and recombinant G-CSF (n = 10). Other causes or associations reported very infrequently include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm, cholesterol embolism, splenic granuloma, congenital diaphragmatic hernia, rib exostosis, pancreatitis, Gaucher's disease, Wilson's disease, pheochromocytoma, afibrinogenemia and ruptured ectopic pregnancy. CONCLUSIONS Emergency physicians should be attuned to the fact that rupture of the spleen can occur in the absence of major trauma or previously diagnosed splenic disease. The occurrence of such a rupture is likely to be the manifesting complaint of an underlying disease. Furthermore, colonoscopy should be more widely documented as a cause of splenic rupture.
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Affiliation(s)
- F Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland, Health Sciences Centre, St. John’s, Newfoundland and Labrador, St Johns, Canada
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, St Johns, Canada
- Discipline of Family Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, St Johns, Canada
| | - Nicholas Sowers
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
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