[Splenic rupture--splenic hematoma].
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Hematoma↗
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Splenic rupture following splenic vein thrombosis in a man with protein S deficiency.
We present a case of spontaneous splenic rupture in a man with splenic vein thrombosis. The splenic vein thrombosis appears to have been caused by protein S deficiency. We are not aware of this having been described before.
Humans↗
[Contribution to the early diagnosis of splenic rupture using radioactive isotopes (author's transl)].
Among the methods of early diagnosis of rupture and trauma of the spleen, fixation of radioactive isotopes is one of the most interesting. An experimental study in the dog of B.M.H.P. metabolism, using B.M.H.P. labelled with Hg-203 and its rate of elimination by the kidney, gives information on lesions of the spleen, in particular, sub-capsular rupture. Splenic trauma reduces the capacity of uptake of mercury by this organ. Excretion in the urine then increases very definitely. This simple and inoffensive method should be used in man.
Animals↗
Limitations of computed tomography in the recognition of delayed splenic rupture.
Delayed splenic rupture is a rare but life threatening complication of abdominal trauma. A case is reported in which initial evaluation by CT did not show hemoperitoneum or splenic laceration in a patient who ruptured his spleen 10 days following the initial injury. The limitations of current diagnostic methods are reviewed.
Adult↗
Hemophilic splenic rupture without thrombocytosis.
Spontaneous splenic rupture in hemophilia A is an uncommon occurrence which is difficult to diagnose. We have reported a case of hemophilic rupture of the spleen unaccompanied by thrombocytosis, which has been emphasized as a diagnostic clue to hemophilic splenic rupture. Hence, splenic rupture should still be considered in any hemophilic patient with pain in the left upper quadrant and a normal platelet count. Splenic rupture in hemophilia must be recognized because its treatment requires not only clotting factor infusion but also surgical intervention.
Adult↗
[Traumatic splenic rupture: when surgical treatment? When conservative treatment? A retrospective study based on 56 cases of traumatic splenic ruptures].
In a retrospective study of 56 cases of traumatic spleen injury we could show that neither ultrasound nor CT-scan influence directly the treatment modality (operative or conservative). Only clinical parameters are of importance.
Adult↗
[Delayed splenic rupture (author's transl)].
Splenic rupture is a common injury associated with blunt abdominal trauma. In contrast, delayed splenic rupture is less frequent and comprises about 8--28% of cases of splenic rupture. The symptom free period can last for days or weeks. The mechanism is explained as follows. A rupture of the parenchyma occurs but the spleen capsula remains intact. A hematoma forms below the capsule and causes a strong overdistension of the capsule so that a bursting and release of blood into the abdominal cavity results. The mortality rate with splenic ruptures in 6--55% and with delayed splenic ruptures 14.6%. Our experiences are reviewed. After commencement of the hemorrhage therapy must consist of treatment for shock and immediate laparotomy and splenectomy.
Adolescent↗
Spontaneous delayed splenic rupture--case report of a five-year interval between trauma and diagnosis.
A 27-year-old white man was admitted in shock with a tender distended abdomen 5 years following significant thoraco-abdominal trauma. Immediately following resuscitation he had an emergency exploratory laparotomy because of his critical condition. At operation 3 liters of old and fresh blood were present intraperitoneally and the spleen was ruptured. The spleen was surrounded by and adherent to the omentum and adjacent viscera. Splenectomy was performed and recovery was uneventful. Histologic examination of the spleen confirmed the 5-year interval between injury and rupture. Delayed splenic rupture accounts for 14% of all splenic injuries and has a high mortality. This case represents the longest reported delay between splenic trauma and delayed rupture.
Adult↗
Traumatic splenic rupture during 30 years. An analysis of 88 cases with special attention to delayed rupture.
Eighty-eight cases of splenic rupture in non-penetrating abdominal injury are analysed. An increasing frequency was seen during the 30-year period studied (1946--1975). Teenagers and young adults were the most affected age groups. A rising incidence of traffic accidents amd multiple iinjuries was noted. Mortality was 21%. All patients with an isolated splenic rupture survived. The complication rate was low. The high incidence of delayed splenic rupture in earlier reports seems to be more a refleciton of the diagnostic diffulties than an actual delayed rupture. We have put the splenic ruptures into minor immediate, major immediate, and delayed. Minor splenic rupture was seen in 20% of patients undergoing operation, major in 75%, and delayed in only 5%. Three of our patients were operated on with splenorrhaphy with an uneventful postoperative course. In minor splenic ruptures, especially in young patients, splenorrhaphy could be a possible way of treatment but more controlled studies are needed before firm recommendations can be made.
Accidents, Traffic↗
Delayed splenic rupture: real or imaginary?
Although splenic injury is the most frequent abdominal injury resulting from blunt trauma, delayed splenic rupture is a rare event. From 1981 to 1990, 75 patients treated at St. Elizabeth Hospital Medical Center (Youngstown, OH) had blunt splenic injury. Splenic rupture was delayed in six of these patients (8%). More severe trauma, such as occurs with motor vehicle accidents, is more likely to lead to immediate rupture. Lesser trauma resulting from minor falls or fights is more likely to lead to delayed rupture. Subcapsular hematoma is the most common etiology for delayed splenic rupture. Although there is no reliable symptom or sign during the latent period, abdominal pain occurs almost uniformly and Kehr's sign is quite common. Peritoneal lavage and abdominal computerized axial tomography scan are accurate in diagnosing splenic rupture. Unfortunately, they are not always reliable in predicting delayed rupture.
Abdominal Injuries↗
A traumatic splenic rupture in a healthy adult.
Splenic rupture in blunt and penetrating trauma is well documented. Other etiologies include hematologic and inflammatory disorders. The case presented documents occult splenic rupture. There was no history of trauma. Furthermore, no evidence of systemic disease or pathology could be found. Occult, spontaneous splenic rupture is rarely diagnosed, although the associated mortality/morbidity is high. The astute clinician must have a high index of suspicion relying on clinical and roentgenographic study for rapid diagnosis and management.
Adult↗
Non-operative management in a case of spontaneous splenic rupture in infectious mononucleosis.
Spontaneous splenic rupture as a complication of infectious mononucleosis was diagnosed in a 19-year-old woman. Sonographic and MRI investigations revealed subcapsular hematoma of the spleen without overt rupture. The patient was managed conservatively. Somatostatin treatment was initiated in order to reduce splanchnic blood flow. Further clinical course of the patient was favourable. Seven days after the diagnosis of splenic rupture the patient was discharged from hospital. Non-operative management should be considered in patients with subcapsular splenic rupture to avoid complications of splenectomy (e.g. post-splenectomy sepsis).
Adult↗
Spontaneous splenic rupture. The role of nonoperative management.
Spontaneous splenic rupture associated with infectious mononucleosis is an infrequent occurrence. Splenectomy has been advocated as the appropriate treatment for these patients. Recently, three patients with spontaneous splenic rupture were successfully treated at our institution without surgery. Management of spontaneous splenic rupture in 37 other patients in the literature was reviewed. Nine of these patients also were treated nonoperatively. Although it has been suggested that splenectomy is the treatment of choice for patients with spontaneous splenic rupture, we believe selective nonoperative treatment of these patients is a realistic and safe option if it is employed appropriately.
Adult↗
Spontaneous splenic rupture following infectious mononucleosis.
Four cases of spontaneous splenic rupture after infectious mononucleosis (IM) have been treated at this institution since 1978. The condition is rare, occurring in 0.1-0.5 per cent of patients with proven infectious mononucleosis. Splenectomy is considered the treatment of choice for these patients. However, because recent trends in the management of traumatic splenic rupture are moving towards nonoperative treatment with selected patients, a similar approach has been considered for the patient with spontaneous splenic rupture following IM. The major reason for avoiding splenectomy is the increased incidence of sepsis in splenectomized patients. Yet, splenic rupture is accompanied by hemorrhage and the risks associated with blood transfusion for ongoing hemorrhage are of similar magnitude as those of sepsis following splenectomy. In addition, the grossly abnormal spleens seen at operation tend to include large, contained hematomas that may also be prone to rupture. Therefore, operative management still appears to be the preferred treatment for spontaneous splenic rupture following IM. Splenectomy is curative, safe, and obviates the need for transfusion, extended hospitalization, and activity restriction.
Adult↗
Spontaneous splenic rupture in infectious mononucleosis.
Spontaneous splenic rupture occurs in association with infectious mononucleosis. Three cases of serologically proven infectious mononucleosis complicated by spontaneous splenic rupture are described. In two, the diagnosis was confirmed preoperatively by abdominal computerized tomographic (CT) scan. Treatment by splenectomy was curative in all three patients. Infectious mononucleosis patients who have acute abdominal pain must be considered for potential splenic hemorrhage.
Adolescent↗
[Hemoperitoneum and splenic rupture in a newborn infant].
Splenic rupture is a rare cause of hemoperitoneum in the neonate. We report on a case of splenic rupture in a full-term neonate with normal spleen following a non-traumatic delivery. The spleen was found to be completely transected and a splenectomy was required. Several etiologies have been proposed: traumatic delivery, in utero fetal trauma prior to delivery, high birth weight, clotting defect, erythroblastosis fetalis. Partial splenectomy or repair of splenic laceration should be performed rather than total splenectomy which can cause severe bacterial sepsis.
Hemoperitoneum↗
Splenic abscess following nonoperative management of splenic rupture.
A recent case of posttraumatic splenic abscess in a young man following nonoperative management of his splenic rupture is reported. With the recent trend toward nonoperative management of hemodynamically stable splenic rupture, the potential complications of splenic abscess may become more common. In view of the high mortality associated with unrecognized splenic abscess, it is important for the clinician to be aware of this entity.
Abscess↗
Failure of conservative management of splenic rupture in a patient with mononucleosis.
"Conservative" management of splenic rupture in patients with mononucleosis has not been adequately evaluated because of its infrequent occurrence. Splenic rupture can be lethal in this setting and is the most common cause of death from mononucleosis. We report a case of spontaneous splenic rupture in a young girl with mononucleosis. The initial management was nonoperative but because of recurrent pain and rebleeding, a splenectomy was later performed. We do not recommend observation of splenic rupture in patients with mononucleosis because of the danger of delayed hemorrhage.
Adolescent↗