Gallstone associated celiac trunk thromboembolisms complicated with splenic infarction:A case report

BACKGROUND Gallstone disease(GD)can have prolonged,subacute inflammatory period before biliary events.The intricate relationship between GD and inflammatory processes can possible lead to prothrombotic tendency that can result in confusing clinical course before diagnosis.CASE SUMMARY A 51-year-old man,presented with a 1-year history of self-relief occasional postprandial upper abdominal pain,had sudden onset severe left upper quadrant pain and visited our emergency room.Contrast enhanced computed tomography(CECT)showed filling defect in celiac trunk,common hepatic,part of splenic arteries and wedge-shaped hypo-enhancing region of spleen,consistent with splenic infarction secondary to splenic arterial occlusion.No convincing predisposing factors were found during first hospitalization.Abdominal pain mildly subsided after low molecular weight heparin and bridge to oral anticoagulant use.However,in the following six months,the patient was admitted twice due to acute cholangitis and finally cholecystitis.Second CECT revealed biliary impacted stone was adjacent to poor dissoluble thrombus.The abdominal pain did not achieve a clinical full remission until endoscopic retrograde cholangiopancreato-graphy stone removal and series laparoscopic cholecystectomy was performed.CONCLUSION This is the first case to present serious thrombotic complication due to inflammation status in chronic GD.It could be a rare,confusing and difficult recognizing cause of a celiac trunk thromboembolic event.

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.

Minimally invasive spleen-preserving distal pancreatectomy: Does splenic vessel preservation have better postoperative outcomes? A systematic review and meta-analysis

BACKGROUND： Minimally invasive spleen-preserving distal pancreatectomy （SPDP） can be performed with either splenic vessel preservation （SVP） or resection [Warshaw procedure （WP）]. The aim of this study was to evaluate the postoperative clinical outcomes of patients undergoing both methods. DATA SOURCES： Database search of PubMed, Embase, Scopus, Cochrane, and Google Scholar was performed （2000-2014）; key bibliographies were reviewed. Qualified studies compar- ing patients undergoing SPDP with either SVP or WP, and as- sessing postoperative complications were included. Calculated pooled risk ratio （RR） with the corresponding 95% confidence interval （CI） by random effects methods were used in the meta-analyses. RESULTS： The search yielded 215 studies, of which only 14 observational studies met our selection criteria. The studies included 943 patients in total; 652 （69%） underwent SVP and 291 （31%） underwent WP. Overall, there was a lower incidence of splenic infarction （RR=0.17; 95% Ch 0.09-0.33; P〈0.001）, gastric varices （RR=0.16; 95% Ch 0.05-0.51; P=0.002）, and intra/postoperative splenectomy （RR=0.20; 95% Ch 0.08-0.49; P〈0.001） in the SVP group. There was no difference in in- cidence of pancreatic fistula （WP vs SVP, 23.6% vs 22.9%;P=0.37）, length of hospital stay, operative time or blood loss. There was moderate cross-study heterogeneity. CONCLUSIONS： SVP is a safe, efficient and feasible technique that may be used to preserve the spleen. WP may be more suit- able for large tumors dose to the splenic hilum or those associ- ated with splenomegaly. Randomized clinical trials are justified to examine the long-term benefits of SVP-SPDP.

Aphasia hemiplegia with abdominal pain in a female pa-tient caused by Staphylococcus lugdunensis infection:a case report

Objective:to describe the clinical fea-tures of a case of infective endocarditis caused by Staph-ylococcus lugdunensis,followed by cerebral embolism,spleen embolism and tendon rupture.Methods:the clin-ical data of a 22-year-old female patient with aphasia hemiplegia and abdominal pain were collected.Relevant examinations such as routine blood test,myocardial en-zyme spectrum,electrocardiogram(ECG),cardiac color Doppler ultrasound,brain magnetic resonance,abdomi-nal computed tomography(CT)and blood culture were completed,and anti infection treatment was carried out according to the drug sensitivity test.Results:brain mag-netic resonance imaging(MRI)showed cerebral infarction in the left basal ganglia,cardiac color Doppler ultrasound showed mitral valve vegetation and abscess formation,and abdominal CT showed splenic infarction.After anti infection treatment,the patient’s condition gradually improved,but the patient had sudden arrhythmia in the recovery period.Color Doppler ultrasound showed rup-ture of the mitral tendinous cord and valve prolapse.The condition was improved after surgical treatment.Conclu-sion:the first manifestation of Staphylococcus lugdunen-sis infection is cerebral infarction,which is relatively rare in the clinic setting.The main manifestation of this case is aphasia hemiplegia with abdominal pain.Blood cul-ture and identification show Staphylococcus lugdunensis,which is rare in adolescent patients.The infection has a rapid onset,rapid progress and causes serious valve dam-age.Timely strain identification and drug sensitivity test are conducive to accurate diagnosis and treatment.Valve surgery is often necessary.