Splenic injuries secondary to colonoscopy:Rare but serious complication

BACKGROUND Colonoscopy is a safe and routine diagnostic and therapeutic procedure for evaluation of large bowel diseases.Most common procedure related complications include bleeding and perforation but rarely a splenic Injury.AIM To investigate the reason for colonoscopy,presentation of patient with spleen injury,types of injury,diagnosis,management and outcomes of patients METHODS A structured search on four databases was done and 45 articles with 68 patients were selected.The reason for colonoscopy,presentation of patient with spleen injury,types of injury,diagnosis,management and outcomes of patients were identified and analyzed using SPSS.RESULTS The mean age of the patients was 62.7 years with 64%females.Twenty two percent had a complete splenic rupture with colonoscopy while 63%had subcapsular hematoma,spleen laceration and spleen avulsion.The most common reason for colonoscopy was screening(46%)followed by diagnostic colonoscopy(28%).Eighty seven percent of patients presented with abdominal pain.Patients with spleen rupture mostly required splenectomy(47%),while minor spleen hematomas and lacerations were managed conservatively(38%).Six percent of the patients were managed with proximal splenic artery splenic embolization and 4%were managed with laparoscopic repair.The overall mortality was 10%while 77%had complete recovery.The reason of colonoscopy against presentation specifically,abdominal pain showed no statistical significance P=0.69.The indication of colonoscopy had no significant impact on incidence of splenic injury(P=0.89).Majority of the patients(47%)were managed with splenectomy while the rest were managed conservatively(P=0.04).This association was moderately strong at a cramer’s V test(0.34).The Fisher exact test showed a higher mortality with spleen rupture(P=0.028).CONCLUSION Spleen rupture due to colonoscopy is a significant concern and is associated with high mortality.The management of the patients can be individualized based on clinical presentation.

Splenic subcapsular hematoma following endoscopic retrograde cholangiopancreatography:A case report and review of literature

BACKGROUND Splenic injury following endoscopic retrograde cholangiopancreatography(ERCP)is a rare complication.The literature contains around 30 articles reporting various degrees of splenic injuries resulting from ERCP since the first report of splenic rupture after ERCP in 1989.CASE SUMMARY This report describes a case of splenic hematoma and stent displacement in a 69-year-old male patient who developed these conditions 7 days after undergoing ERCP and stenting.The patient had bile duct stenosis caused by a malignant tumor that was obstructing the bile duct.The diagnosis was confirmed by epigastric computed tomography and magnetic resonance cholangiopancreatography.The patient was successfully treated with percutaneous transhepatic cholangial drainage,endoscopic pyloric stent placement,and conservative management.The causes of splenic injury following ERCP are discussed.CONCLUSION ERCP has the potential to cause splenic injury.If a patient experiences symptoms such as abdominal pain,decreased blood pressure,and altered hematology after the procedure,it's important to be thoroughly investigated for postoperative bleeding and splenic injury.

Traumatic Splenic Injuries in Khartoum, Sudan

Background: Spleen injuries are most commonly associated with blunt abdominal trauma and represent a potentially life-threatening condition. Objectives: To study the pattern of splenic injuries of the patient, management instituted and its outcome at Khartoum. Patients and Methods: This is a prospective, analytic and hospital-based multicenteric study, conducted at the three main Teaching hospitals at Khartoum. The study was carried over a period from April 2012 to February 2013. It includes all patients, diagnosed as traumatic splenic injury. Excluded were patients with history of splenic disease, iatrogenic injury or spontaneous rupture. Results: The study included 47 patients: their mean age was 26.4 years (SD ± 14.5). Most of them 41 (87.2%) were in the first four decades of life. Males were predominant 41 (87.2%), with a male to female ratio of 6.8:1. The majority of our patients had blunt abdominal trauma 39 (83%), of whom, road traffic accident accounted for 51.1% and none reported cases of gunshot. Isolated splenic injury was found in 23 (48.9%), and Haemodynamic stability was seen in 27 (57.4%) on presentation. The initial haemoglobin assessment revealed <9 gram/dl in 53.2%. CT scan was performed to 24 (51.1%), of whom 66 patients were Grade I and II and none of our patients were diagnosed as Grade V. Blood transfusion was required in 42 (89.4%). Operative treatment was adopted in 66% (61.7% total splenectomy and 4.3% splenorrhaphy), while selective non-operative management was successful in 16 (34%) of the patients. Higher intra-operative grade of splenic injury was found to be significantly associated with blunt abdominal trauma, haemodynamic instability and associated intra-abdominal injuries. 44 patients (93.6%) were discharged home in a general good condition. The morbidity and mortality were seen in 8.5% and 6.4% respectively. Conclusion: Splenic injuries usually follow blunt abdominal trauma, particularly after road traffic accidents. It is common during the first four decades of life with males being frequently affected. The great success rate of adopting selective non-operative management is worthwhile.

The effects of low-dose splenic irradiation and radiotherapy on immune system of patients with locally advanced non-small cell lung cancer

Objective： The aim of the research was to study the effects of low-dose splenic irradiation and radiotherapy on immune system of patients with locally advanced non-small cell lung cancer （NSCLC）. Methods： Twelve cases of stage III NSCLC in Tumor Radiotherapy Center of our hospital （the Affiliated Hospital of Medical College Qingdao University, China） were collected from July 2011 to July 2012; all patients were under 75 years old with clear pathology, measurable lesions and good personal statement. They were randomly divided into combined treatment group （D1 ＋ D2） and control group （D1）. The control group （D1） only received radiotherapy to the chest; combined treatment group （D1 ＋ D2） received low-dose splenic irradiation plus conventional dose irradiation. Flow cytometry was used to detect the peripheral blood T lymphocyte immune indexes of patients before, during and after the treatment, classification by five blood cell analyzer was used to determine white blood cells, neutrophils, hemoglobin and platelet count. The radiation induced toxicity including esophagitis, pneumonia and gastrointestinal reaction was observed, as well as the dose when it happened. Results： There was no significant difference in the ratio between two groups in cells CD4＋, CD8＋ and CD4＋/CD8＋ after radiotherapy （P 〉 0.05）. There was no change in these indicators in combined treatment group after treatment （P 〉 0.05）, but it decreased in control group （P 〈 0.05）. There was no significant difference in the incidences of radiation esophagitis, pneumonia, gastrointestinal reactions and bone marrow suppression between two groups （P 〉 0.05）, but the patients in combined treatment group seemed to tolerate high dose well （P 〈 0.05）. Conclusion： Low-dose splenic irradiation combined with radiotherapy to the chest can alleviate the injury degree of acute radiation induced the toxicity of locally advanced NSCLC patients, through affect the patient＇s immune function.

警惕漏诊创伤性膈肌损伤中合并腹腔脏器损伤

目的 总结创伤性膈肌损伤患者术前可能遗漏腹腔脏器损伤患者的临床特点和原因,探究此类患者行腹部探查的必要性。方法 回顾分析2013年9月—2023年8月胸外科急诊收治的术前漏诊腹腔脏器损伤的创伤性膈肌损伤患者13例的临床资料。结果 13例中男12例、女1例,平均年龄42.5岁。8例为穿透性损伤,5例为钝性损伤。患者因胸腔探查发现膈肌损伤,随后行腹腔探查,结果显示肝损伤4例,胃损伤4例,脾损伤3例,肠系膜损伤2例,小肠损伤1例,下腔静脉损伤1例,胰腺损伤1例。所有患者行膈肌修补术,腹腔脏器损伤行相应手术或保守治疗。所有患者均痊愈,无死亡患者。结论 当胸腔探查手术发现膈肌损伤时,即使术前腹部体征及影像学表现阴性也应积极行腹腔探查,以及时发现可能合并的腹腔脏器损伤,避免漏诊及误诊,改善患者预后。

富马酸二甲酯抑制NLRP3/AIM2炎性小体防治脾脏组织辐射损伤

目的探讨富马酸二甲酯(dimethyl fumarate,DMF)对γ射线辐射所致小鼠脾脏损伤的防护作用及机制。方法将C57BL/6J小鼠随机分为空白对照组、辐射模型组、DMF给药组,于辐照前12 h,辐照后0.5、12、24、48 h各给药一次。检测经60Coγ射线一次性全身照射(8 Gy)后,小鼠30 d存活率、体质量变化及照射后小鼠脾脏病理损伤;TUNEL染色法检测脾脏细胞凋亡;酶联免疫吸附法(ELISA)检测脾脏中TNF-α、IL-1β、IL-6、IL-18、NLRP3及AIM2含量变化;Western blot实验和免疫荧光染色实验验证辐照后脾脏组织中NLRP3、AIM2含量变化。结果DMF能明显提高辐照后小鼠的存活率,改善照射后小鼠体质量降低情况,减轻脾脏病理损伤,并抑制辐照后脾脏细胞凋亡;ELISA实验结果显示DMF可以显著抑制照射导致的脾脏炎症因子TNF-α、IL-1β、IL-6、IL-18和炎性小体组分NLRP3、AIM2升高;Western blot实验和组织免疫荧光染色也证实,DMF能抑制辐照导致的NLRP3、AIM2炎性小体蛋白水平升高,同时NLRP3激动剂、AIM2激动剂能拮抗DMF对脾脏细胞的辐射防护作用。结论DMF对^(60)Coγ射线损伤小鼠脾脏损伤有明显改善作用,其机制与NLRP3/AIM2炎性小体密切相关,可作为辐射损伤防护药物潜在研究对象。

专业Bundles策略护理在骨折合并脾脏损伤护理中的应用价值

目的:探讨与分析专业Bundles策略护理在骨折合并脾脏损伤护理中的应用价值.方法:选择2021年2月—2023年2月我院收治的76例骨折合并脾脏损伤患者为研究对象,根据随机信封抽签1∶1原则将其分为Bundles组与对照组,各38例.对照组在围手术期实施常规护理,Bundles组在对照组基础上给予围手术期专业Bundles策略护理,2组护理观察时间均为14 d.记录2组患者的预后恢复、心理变化、并发症与护理满意度情况.结果:Bundles组术中出血量少于对照组,手术时间、术后肛门排气时间、术后肛门排便时间、术后下床活动时间、术后住院时间均短于对照组,组间差异有统计学意义(P<0.05);护理14 d后,2组SDS、SAS评分均低于护理前,且Bundles组低于对照组,差异有统计学意义(P<0.05);Bundles组并发症发生率低于对照组,差异有统计学意义(P<0.05);Bundles组护理满意度高于对照组,差异有统计学意义(P<0.05).结论:专业Bundles策略护理在骨折合并脾脏损伤护理中的应用能促进患者康复,可减少创伤,缓解患者的焦虑与抑郁情绪,并且还能提高安全性,减少不良事件的发生,患者更加满意.

First report of splenic rupture following deep enteroscopy

Splenic rupture is a rare complication of diagnostic and therapeutic gastrointestinal endoscopy procedures.Herein,we report for the first time a case of splenic rupture following therapeutic retrograde double-balloon enteroscopy,which occurred in an 85-year-old man who was treated for recurrent mid-intestinal bleeding that resulted from ileal angioectasia.This patient promptly underwent an operation and eventually recovered.

The impacts of different embolization techniques on splenic artery embolization for blunt splenic injury: a systematic review and meta-analysis

Background: Splenic artery embolization(SAE) has been an effective adjunct to the Non-operative management(NOM) for blunt splenic injury(BSI). However, the optimal embolization techniques are still inconclusive. To further understand the roles of different embolization locations and embolic materials in SAE, we conducted this system review and meta-analyses.Methods: Clinical studies related to SAE for adult patients were researched in electronic databases, included Pub Med, Embase, Science Direct and Google Scholar Search(between October 1991 and March 2013), and relevant information was extracted. To eliminate the heterogeneity, a sensitivity analysis was conducted on two reduced study sets. Then, the pooled outcomes were compared and the quality assessments were performed using Newcastle-Ottawa Scale(NOS). The SAE success rate, incidences of life-threatening complications of different embolization techniques were compared by χ2 test in 1 st study set. Associations between different embolization techniques and clinical outcomes were evaluated by fixed-effects model in 2 nd study set.Results: Twenty-three studies were included in 1 st study set. And then, 13 of them were excluded, because lack of the necessary details of SAE. The remaining 10 studies comprised 2 nd study set, and quality assessments were performed using NOS. In 1 st set, the primary success rate is 90.1% and the incidence of life-threatening complications is 20.4%, though the cases which required surgical intervention are very few(6.4%). For different embolization locations, there was no obvious association between primary success rate and embolization location in both 1 st and 2 nd study sets(P >0.05). But in 2 nd study set, it indicated that proximal embolization reduced severe complications and complications needed surgical management. As for the embolic materials, the success rate between coil and gelfoam is not significant. However, coil is associated with a lower risk of life-threatening complications, as well as less complications requiring surgical management.Conclusion: Different embolization techniques affect the clinical outcomes of SAE. The proximal embolization is the best option due to the less life-threatening complications. For commonly embolic material, coil is superior to gelfoam for fewer severe complications and less further surgery management.

Splenic rupture following colonoscopy

Colonoscopy is a safe and routinely performed diagnostic and therapeutic procedure for different colorectal diseases. Although the most common complications are bleeding and perforation, extracolonic or visceral injuries have also been described. Splenic rupture is a rare complication following colonoscopy, with few cases reported. We report a 60-year-old female who presented to surgical consultation 8 h after a diagnostic colonoscopy. Clinical, laboratory and imaging findings were suggestive for a massive hemoperitoneum. At surgery, an almost complete splenic disruption was evident, and an urgent splenectomy was performed. After an uneventful postoperative period, she was discharged home. Splenic injury following colonoscopy is considered infrequent. Direct trauma and excessive traction of the splenocolic ligament can explain the occurrence of this complication. Many times the diagnosis is delayed because the symptoms are due to colonic insuffl ation, so the most frequent treatment is an urgent splenectomy. A high index of suspicion needs an early diagnosis and adequate therapy.

The Incidence of Splenic Injury Following Blunt Abdominal Trauma (BAT), Sultan Qaboos University Hospital Experience

The aim of the study was to review traumatic splenic injury following blunt abdominal trauma (BAT), during the period from January 2009 to January 2015 at SQUH. The data for this study was retrospectively collected. It included 768 patients admitted to SQUH general surgery department following BAT. 43 patients with splenic injury were identified (34 males, 9 females). The mean age of patients with splenic injury was 36.0 years (34.4 years for males, 42.1 years for females). The most common mechanism of injury was motor vehicle collision (90.7%). Grade I, II are the most common grades of splenic injury. Non-Omani patients accounted for (51.2%) and most of them were pedestrians at the time of trauma. Ribs fracture is the most common injury associated with splenic injury. 36 (83.7%) patients were managed conservatively and 7 (16.3%) patients were splenectomized. Angioembolization was done for 11 (30.6%) patients. Despite the small population of Oman, high incidence of motor vehicle collision (MVC) increases the incidence of splenic injury among young age group.

Antiphospholipid syndrome with renal and splenic infarction after blunt trauma:A case report

BACKGROUND In trauma patients,bleeding is an immediate major concern.At the same time,there are few cases of acute vascular occlusion after blunt trauma,and it is unclear what assessment and diagnosis should be considered for these cases.Herein,we describe a patient diagnosed with antiphospholipid syndrome after a hypercoagulable workup for acute renal and splenic vascular occlusion due to blunt trauma.CASE SUMMARY A 20-year-old man was admitted to the emergency department with abdominal pain after hitting a tree while riding a sled 10 h ago.He had no medical history.Radiological investigations revealed occlusion of the left renal artery with global infarction of the left kidney and occlusion of branches of the splenic artery with infarction of the central portion of the spleen.Attempted revascularization of the left renal artery occlusion through percutaneous transluminal angioplasty failed due to difficulty in passing the wire through the total occlusion.Considering the presence of acute multivascular occlusions in a young man with low cardiovascular risk,additional laboratory tests were performed to evaluate hypercoagulability.The results suggested a high possibility of antiphospholipid syndrome.Treatment with a subcutaneous injection of enoxaparin was started and changed to oral warfarin after two weeks.The diagnosis was confirmed,and he continued to visit the rheumatology outpatient clinic while taking warfarin.CONCLUSION A hypercoagulable workup can be considered in trauma patients with acute multivascular occlusion,especially in young patients with low cardiovascular risk.

Splenic laceration following endoscopic retrograde cholangiopancreatography:A literature review and our experience

Endoscopic retrograde cholangiopancreatography(ERCP)is an invasive procedure,which is widely used in the management of pancreas and biliary tract diseases.It may induce complications,such as pancreatitis,bleeding,and perforation.Splenic injury is an extremely rare but life threatening complication.We reviewed the literature,and found that 23 ERCP associated splenic injuries cases had been reported.We discussed the likely mechanism,clinical features,diagnostic modality,and treatment,also shared our experience on a patient who suffered splenic laceration after ERCP and was successfully treated by splenectomy.

消化道内镜治疗术后并发脾损伤3例

内镜治疗是消化道良性肿瘤和早癌的常用治疗手段,临床上最常见的并发症为出血和穿孔,并发脾损伤者极少见,严重者可危及生命。因此,早期识别、及时诊断和治疗对于改善内镜治疗术后并发脾损伤患者的预后至关重要。本文报道3例消化道内镜治疗术后并发脾损伤病例,以期提高临床医师对这一内镜治疗罕见并发症的认知。

结肠镜检查致脾损伤1例报告并文献复习

脾损伤是结肠镜检查极为少见的并发症。然而,脾损伤病情进展迅速,若不重视,则可能导致患者死亡。本文分析1例结肠镜检查致脾损伤患者的临床资料,并结合相关文献对结肠镜检查致脾损伤发生原因、临床表现、诊断和治疗进行总结,以期提高医疗人员对结肠镜检查致脾损伤的认识。

电针对大鼠全脑缺血再灌流损伤的保护作用

结扎基底动脉后夹闭双侧颈总动脉１０分钟，造成大鼠全脑缺血再灌流损伤模型，观察了电针对其保护作用。结果表明：与模型组相比电针可延长皮层脑电图（ＥＥＧ）消失时间、缩短ＥＥＧ出现时间和恢复时间、降低脑组织含水率和Ｃａ＋＋、Ｎａ＋含量、降低脑组织过氧化脂质（ＬＰＯ）含量。表明电针对大鼠全脑缺血再灌流损伤有保护作用。

督脉电针治疗大鼠全横断性脊髓损伤的实验研究

目的 :探讨督脉电针对大鼠全横断性脊髓损伤的行为和结构修复的影响。方法 :用BBB评分法和爬网格试验检测全横断性脊髓损伤及督脉电针治疗后大鼠的运动功能 ,荧光金逆行标记法检测再生神经元 ,用生长相关蛋白 43 (GAP 43 )免疫组织化学法观察脊髓损伤区周围神经元GAP 43的表达。结果 :督脉电针治疗后大鼠后肢运动功能有明显地恢复 ,损伤区脊髓组织退变减轻 ,躯体感觉运动区内锥体细胞层及红核内的神经元密度增大 ,脊髓组织内GAP 43阳性神经元增多 ,在脊髓横断头侧端灰质内、躯体运动感觉区及红核内有少量被标记细胞。结论 :督脉电针治疗可减轻脊髓损伤后的继发性损伤 。

未控制出血性休克早期液体复苏的实验研究

目的 :探讨未控制出血性休克限制性液体复苏的效果。方法 :Wistar大鼠 6 0只 ,采用 Krausz标准脾脏损伤 +切断脾中部一动脉分支制作重度未控制出血性休克模型后 ,随机分为 6组 (n=10 ) :未输液复苏组(NF组 )及平均动脉压维持在 6 .6 7k Pa(1k Pa=7.5 mm Hg)组 (NS5 0组 )、8.0 0 k Pa组 (NS6 0组 )、10 .70 k Pa组 (NS80组 )、13.30 k Pa组 (NS10 0组 )和结扎止血后使平均动脉压维持在 13.30 k Pa组 (止血输液组 )。各输液组在平均动脉压降至 5 .33k Pa时开始用平衡盐液复苏 ,使血压分别维持在各相应水平 ,观察各组动物的出血量、输液量、存活率、存活时间及各时间点的血压、血乳酸、碱缺失和血细胞比容 (Hct)的变化情况。结果 :NS5 0组的出血量、输液量明显低于 NS80、NS10 0组 (P均 <0 .0 5 ) ,存活率明显高于 NS80、NS10 0组和未输液组(P均 <0 .0 5 ) ,存活时间比未输液组、NS80和 NS10 0组明显延长 (P均 <0 .0 5 ) ;随着维持血压的增高 ,Hct逐渐降低 ,伤后 12 0分钟 NS5 0组明显高于 NS6 0组、NS80组和 NS10 0组 (P均 <0 .0 5 ) ;在各时间点 ,血乳酸和碱缺失随着复苏血压的增高而逐渐降低 ,伤后 6 0分钟 ,NS5 0组明显高于 NS6 0组、NS80组、NS10 0组和止血输液组 (P均 <0 .0 5 )。结扎止血组各项指?

头穴透刺配合溶栓治疗急性脑梗塞的基础与临床研究(Ⅰ)——针刺对大鼠脑缺血再灌注脑血流的影响

采用脑血流量、脑内ＡＴＰ、葡萄糖、乳酸量和脑水分含量为指标，分别观测针刺组与对照组在大鼠前脑缺血６０ｍｉｎ条件下，再灌注０ｍｉｎ、１０ｍｉｎ、６０ｍｉｎ、１２０ｍｉｎ各时间点上的数值变化，对其进行详细分析。结果表明：针刺组的脑血流量、脑能量代谢、脑水肿都得到了明显改善，特别是再灌注６０ｍｉｎ和１２０ｍｉｎ时，减缓了由再灌注时间的延长而引起的迟发性低灌注，对脑缺血再灌注损伤起到了保护作用。

电针八髎、会阳治疗脊髓损伤性尿潴留疗效观察

目的探寻治疗脊髓损伤性尿潴留的较佳疗法。方法将84例观察病例随机分为治疗组(46例)和对照组(38例)。治疗组采用电针八髎、会阳穴,对照组采用常规取穴电针治疗。结果治疗组总有效率为82.6%,痊愈率为43.5%;对照组分别为63.2%、23.7%。两组间差异有非常显著性意义(P<0.01)。结论电针八髎、会阳穴治疗脊髓损伤性尿潴留疗效优于常规取穴电针疗法。