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Habash M, Ceballos D, Gunn AJ. Splenic Artery Embolization for Patients with High-Grade Splenic Trauma: Indications, Techniques, and Clinical Outcomes. Semin Intervent Radiol 2021; 38:105-112. [PMID: 33883807 DOI: 10.1055/s-0041-1724010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The spleen is the most commonly injured organ in blunt abdominal trauma. Patients who are hemodynamically unstable due to splenic trauma undergo definitive operative management. Interventional radiology plays an important role in the multidisciplinary management of the hemodynamically stable trauma patient with splenic injury. Hemodynamically stable patients selected for nonoperative management have improved clinical outcomes when splenic artery embolization is utilized. The purpose of this article is to review the indications, technical aspects, and clinical outcomes of splenic artery embolization for patients with high-grade splenic injuries.
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Affiliation(s)
- Majd Habash
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Darrel Ceballos
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew J Gunn
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
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Chan VSH, Mak YH, Kwong YL, Lam SHY. Non-traumatic splenic rupture secondary to haemorrhagic infarct in diffuse large B-cell lymphoma. BMJ Case Rep 2019; 12:12/1/e229052. [PMID: 30659004 DOI: 10.1136/bcr-2018-229052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Yuen Hei Mak
- Department of Radiology, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Yok-Lam Kwong
- Department of Medicine, Queen Mary Hospital, Hong Kong, Hong Kong
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Kaniappan K, Lim CTS, Chin PW. Non-traumatic splenic rupture - a rare first presentation of diffuse large B-cell lymphoma and a review of the literature. BMC Cancer 2018; 18:779. [PMID: 30068299 PMCID: PMC6090959 DOI: 10.1186/s12885-018-4702-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 07/27/2018] [Indexed: 11/27/2022] Open
Abstract
Background Cases of non-traumatic splenic rupture are rare and entails a potentially grave medical outcome. Hence, it is important to consider the differential diagnosis of a non-traumatic splenic rupture in patients with acute or insidious abdominal pain. The incidence of rupture in Diffuse B-cell non-Hodgkin Lymphoma is highly infrequent (Paulvannan and Pye, Int J Clin Pract 57:245–6, 2003; Gedik et el., World J Gastroenterol 14:6711–6716, 2008), despite reports of various non-traumatic splenic rupture in the literature (Orloff and Peksin, Int Abstr Surg 106:1-11, 1958; Paulvannan and Pye, Int J Clin Pract 57:245–6, 2003). In this article, we attempt to highlight the features of a rare cause of splenic rupture that might serve as a future reference point for the detection of similar cases during routine clinical practice. Case presentation A 40-year-old man presented with 1 week history of left hypochondriac pain associated with abdominal distention. There was no history of preceding trauma or fever. Clinical examination revealed signs of tachycardia, pallor and splenomegaly. He had no evidence of peripheral stigmata of chronic liver disease. In addition, haematological investigation showed anemia with leucocytosis and raised levels of lactate dehydrogenase enzyme. However, peripheral blood film revealed no evidence of any blast or atypical cells. In view of these findings, imaging via ultrasound and computed tomography of the abdomen was performed. The results of these imaging tests showed splenic collections that was suggestive of splenic rupture and hematoma. Patient underwent emergency splenectomy and the histopathological report confirmed the diagnosis as DLBCL. Conclusions The occurrence of true spontaneous splenic rupture is uncommon. In a recent systematic review of 613 cases of splenic rupture, only 84 cases were secondary to hematological malignancy. Acute leukemia and non-Hodgkin lymphoma were the most frequent causes of splenic rupture, followed by chronic and acute myelogeneous leukemias. At present, only a few cases of diffuse large B-cell lymphoma (DLBCL) have been reported. The morbidity and mortality rate is greatly increased when there is a delay in the diagnosis and intervention of splenic rupture cases. Hence, there should be an increased awareness amongst both physicians and surgeons that a non-traumatic splenic rupture could be the first clinical presentation of a DLBCL.
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Affiliation(s)
| | - Christopher Thiam Seong Lim
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Malaysia.
| | - Pek Woon Chin
- Department of Internal Medicine, Hospital Enche Besar Hajjah Khalsom, Kluang, Johor, Malaysia
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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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Hamidian Jahromi A, Migliaro M, Romano M, Sangster G. Delayed Splenic Rupture; Normal Appearing Spleen on the Initial Multidetector Computed Tomography (MDCT) Can Sometimes Be Misleading. Trauma Mon 2016; 21:e24465. [PMID: 28184357 PMCID: PMC5292018 DOI: 10.5812/traumamon.24465] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 12/17/2014] [Accepted: 12/23/2014] [Indexed: 11/26/2022] Open
Abstract
Introduction Delayed splenic rupture (DSR) is an unusual outcome following blunt abdominal trauma. Although DSR is defined as bleeding more than 48 hours after blunt trauma in a previously hemodynamically stable patient, a review of the reported cases in the literature shows that in almost all of the cases the initial CT imaging revealed some form of damage to the spleen. Case Presentation Here we describe an extremely rare condition in a case that presented with a DSR following blunt trauma and had a normal appearing spleen in the initial post trauma MDCT scan. Conclusions DSR is a serious consequence of trauma and is associated with a significantly higher mortality rate compared with the overall mortality for acute splenic injuries. A High index of suspicion along with the liberal serial utilization of the imaging studies are the essential elements for early detection of DSR. We propose that DSR be considered as a differential diagnosis in patients presenting with hemodynamic instability late post trauma, even when the immediate post trauma MDCT scan has shown a normal appearing spleen. We suggest that every patient with a high impact injury or injuries to peri-splenic organs should have a repeat MDCT scan 2 - 3 days post trauma or before the patients is discharged from hospital.
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Affiliation(s)
| | - Matias Migliaro
- Department of Radiology, Fundacion Escuela de Medicina Nuclear, Mendoza, Argentina
| | - Melisa Romano
- Department of Radiology, El Carmen Hospital, Mendoza, Argentina
| | - Guillermo Sangster
- Department of Radiology, Louisiana State University Health Shreveport, LA, United States
- Corresponding author: Guillermo Sangster, Department of Radiology, Louisiana State University Health Shreveport, LA, United States. Tel: +318-6756345, E-mail:
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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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Al-Jafar HA, Taqi A, Madda JP, Abdullah TA. Splenectomy complicated by sustained extreme thrombocytosis and extensive portosplenomesenteric vein thrombosis in pyrimidine 5'-nucleotidase deficiency. BMJ Case Rep 2013; 2013:bcr-2013-201061. [PMID: 24287477 DOI: 10.1136/bcr-2013-201061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Reactive and redistributional thrombocytosis is a well-known postsplenectomy occurrence .Usually it is transient and it rarely reaches extreme levels. We report a rare case of haemolytic anaemia where splenectomy was carried out following trauma to a massively enlarged spleen and was followed by extreme sustained thrombocytosis associated with extensive portal, splenic and mesenteric vein thrombosis despite standard antithrombotic prophylaxis.
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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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Sowers N, Aubrey-Bassler FK. Trivial trauma and delayed rupture of a normal spleen: a case report. J Med Case Rep 2011; 5:591. [PMID: 22189181 PMCID: PMC3259121 DOI: 10.1186/1752-1947-5-591] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 12/21/2011] [Indexed: 05/26/2023] Open
Abstract
INTRODUCTION Although a majority of splenic ruptures present acutely with a known mechanism of injury, a minority of patients present days to weeks following trauma with a delayed rupture. Also uncommon is the atraumatic rupture, the vast majority of which occur in patients with underlying splenic pathology. A handful of cases of apparently spontaneous rupture of a normal spleen are reported; however, there is debate about whether these actually represent delayed ruptures following a history of trauma that is not elicited. Although a few cases of delayed rupture of the spleen following trivial trauma have been reported, the majority of these present evidence of an underlying disease process. We found only two such cases that documented a normal spleen and three cases where underlying splenic pathology was not reported. We review the literature and discuss the phenomenon of delayed rupture of the normal spleen following trivial trauma. CASE PRESENTATION A 27-year-old Caucasian man with no underlying splenic pathology presented with splenic rupture one week after playfully wrestling with his partner. The patient did not present at the time of the injury and only recalled it upon repeated questioning after computed tomography diagnosis. CONCLUSIONS This case lends support to the theory that the normal spleen can rupture some time after trivial trauma, which seems like a more plausible explanation than rupture without cause. However, given the dearth of similar reports in the literature, the possibility remains that the association we have observed is not causational.
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Affiliation(s)
- Nicholas Sowers
- Primary Healthcare Research Unit, Memorial University of Newfoundland, St, John's, NL, Canada.
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