Successful splenic artery embolization in a patient with Behçet’s syndrome-associated splenic rupture:A case report

BACKGROUND Splenic rupture associated with Behçet’s syndrome(BS)is extremely rare,and there is no consensus on its management.In this case report,a patient with BSassociated splenic rupture was successfully treated with splenic artery embolization(SAE)and had a good prognosis after the intervention.CASE SUMMARY The patient was admitted for pain in the left upper abdominal quadrant.He was diagnosed with splenic rupture.Multiple oral and genital aphthous ulcers were observed,and acne scars were found on his back.He had a 2-year history of BS diagnosis,with symptoms of oral and genital ulcers.At that time,he was treated with oral corticosteroids for 1 month,but the symptoms did not alleviate.He underwent SAE to treat the rupture.On the first day after SAE,the patient reported a complete resolution of abdominal pain and was discharged 5 d later.Three months after the intervention,a computed tomography examination showed that the splenic hematoma had formed a stable cystic effusion,suggesting a good prognosis.CONCLUSION SAE might be a good choice for BS-associated splenic rupture based on good surgical practice and material selection.

Abdominal Trauma during Pregnancy with Splenic Rupture and Fetal Death in Utero at Bogodogo University Hospital: A Case Report

Splenic injury caused by abdominal trauma during pregnancy is rare. Splenic injury associated with fetal death in utero following a fall from a tree top is even rarer. The authors report a case of splenic trauma associated with fetal death in utero following a fall from the top of a tree in a 19-year-old pregnant woman at 30 weeks amenorrhoea. She was referred from a 1st level health facility for trauma that had occurred the day before admission. She was in poor general condition (WHO performance status IV) and had a cardiovascular collapse. Ultrasound was used to diagnose haemoperitoneum and fetal death in utero. A CT scan was used to diagnose splenic lesions. Treatment consisted of splenectomy and caesarean section after resuscitation.

Non-traumatic splenic rupture:Report of seven cases and review of the literature

AIM： TO evaluate seven patients with non-traumatic splenic rupture （NSR）. NSR is an uncommon dramatic abdominal emergency that requires immediate diagnosis and prompt surgical treatment to ensure the patient＇s survival. METHODS： Within 11 years, seven cases were evaluated for patient characteristics, anamnesis and symptoms, method of diagnosis, findings of laparotomy, and etiology of NSR. RESULTS： There were six （86%） male and one female （14%） patient, whose mean age was 36 ± 12.8 （17-56） years. We report here four cases of Plasmodium vivax malaria （cases Ⅰ-Ⅳ）, one case of hemodialysis （case Ⅴ）, one case of spontaneous splenic rupture （case Ⅵ）, and one case of hairy cell leukemia （case Ⅶ）. Splenectomy was performed in all patients. All of them made an uneventful recovery and were discharged in stable condition. CONCLUSION： NSR is a rare entity that needs a high index of suspicion for diagnosis. Using ultrasonography or computer tomography, and peritoneal aspiration of fresh blood may assist in the diagnosis of NSR. Increased awareness of NSR can enhance early diagnosis and effective treatment.

Atraumatic splenic rupture after cocaine use and acute Epstein-Barr virus infection: A case report and review of literature

BACKGROUND Atraumatic splenic rupture(ASR)accounts for just over 3%of all cases of splenic rupture and is associated with a high mortality rate.The most common culprit is acute infection with Epstein-Barr virus(EBV)but other documented aetiologies include neoplasia,other viral/bacterial infections,acute and chronic pancreatitis,amyloidosis and anticoagulant medications.There are four previous reports of cocaine-associated ASR but never before has it been documented in combination with concurrent acute EBV infection.CASE SUMMARY A 21-year-old man presented to hospital with acute left shoulder pain which radiated to the right shoulder and upper abdomen.He denied any history of recent trauma and had no relevant past medical history.He took no regular prescription medications but had used cocaine within the previous 24 h.Investigations revealed splenomegaly,a Grade 3 subcapsular splenic haematoma,moderate haemoperitoneum and an incidental 9 mm splenic artery pseudoaneurysm.There was also serological evidence of acute EBV infection.Prophylactic endovascular embolisation of the pseudoaneurysm was performed and the splenic rupture was managed non-operatively.The patient remained admitted in hospital for seven days and did not require any transfusion of blood products.Serial imaging showed complete resolution of the haemoperitoneum after 5 wk.The importance of abstinence from illicit drug use was emphasised to the patient but it is unknown whether or not he remains compliant.CONCLUSION This case demonstrates that ASR is a rare condition that can result from acute EBV infection and cocaine ingestion and requires a high index of suspicion to diagnose clinically.

Severe splenic rupture after colorectal endoscopic submucosal dissection

Splenic rupture(SR)after colonoscopy is a very rare but potentially serious complication.Delayed diagnosis is common,and may increase morbidity and mortality associated.There is no clear relation between SR and difficult diagnostic or therapeutic procedures,but it has been suggested that loop formation and excessive torquing might be risk factors.This is a case of a65-year-old woman who underwent endoscopic submucosal dissection(ESD)for lateral spreading tumor in the descending colon,and 36 h afterwards presented symptoms and signs of severe hypotension due to SR.Standard splenectomy was completed and the patient recovered uneventfully.Colorectal ESD is usually a long and position-demanding technique,implying torquing and loop formation.To our knowledge this is the first case of SR after colorectal ESD reported in the literature.Endoscopists performing colorectal ESD in the left colon must be aware of this potential complication.

Acute pancreatitis complicated with splenic rupture: A case report

Atraumatic splenic rupture is an uncommon complication of acute pancreatitis. This report describes the case of a 30-year-old man with acute pancreatitis and splenic vein thrombosis complicated by splenic rupture. The patient was admitted to the emergency department with pain in the upper abdomen that had been present for six hours and was associated with vomiting and sweating. He was diagnosed with acute pancreatitis of alcoholic etiology. Upon computed tomography(CT) of the abdomen, the pancreatitis was scored as Balthazar C grade, and a suspicious area of necrosis affecting 30% of the pancreas with splenic vein thrombosis was revealed. Seventytwo hours after admission, the patient had significant improvement in symptoms. However, he showed clinical worsening on the sixth day of hospitalization, with increasing abdominal distension and reduced hemoglobin levels. A CT angiography showed a large amount of free fluid in the abdominal cavity, along with a large splenic hematoma and contrast extravasation along the spleen artery. The patient subsequently underwent laparotomy, which showed hemoperitoneum due to rupture of the splenic parenchyma. A splenectomy was then performed, followed by ultrasound-guided percutaneous drainage.

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.

First splenic rupture following an endoscopic esophageal myotomy:A case report

BACKGROUND The occurrence of splenic rupture is extremely rare during an upper gastrointestinal endoscopy.Although infrequent,splenic rupture is a known complication secondary to colonoscopy.However,occurrence of splenic rupture after peroral endoscopic myotomy(POEM)has never been reported to date.CASE SUMMARY We describe a case of a splenic rupture following a POEM for recurrent achalasia in a patient who previously had a Heller myotomy.Splenic rupture remains very uncommon after an upper gastro-intestinal endoscopic procedure.The most plausible cause for this rare splenic injury appears to be the stretching of the gastro-splenic ligament during the endoscopy.A previous surgery may be a risk factor contributing to this complication.CONCLUSION The possibility for the occurrence of specific complications,such as splenic rupture,does exist even with the development of advanced endoscopic procedures,as presented in the present case after POEM.

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.

Expert consensus on interventional therapy for traumatic splenic bleeding

This study aims to introduce the diagnosis and treatment processes of traumatic splenic bleeding and explain its emergency,medical,interventional,and surgical treatments.Furthermore,this study aims to summarize the indications and contraindications of splenic artery embolization,interventional procedures,and precautions of complications.

Blunt Traumatic Pericardial Rupture<br/>—Case Report and Literature Review

Pericardial rupture following blunt chest trauma is rare and associated with high mortality rate ranging from 30% to 64%. We review 42 cases which have been reported in the literature in last 17 years and report a case of our own. We have found that 83% of the cases were men with a mean age of 49 years. The most frequent cause was traffic accidents (79%). Preoperative diagnosis of traumatic rupture of the pericardium has been improved in recent 17 years, and the result is satisfactory. Early detection, timely treatment is the key. Pneumopericardium may be a valuable radiographic clue for diagnosis. The management of pericardial rupture is mainly to avoid the risk of cardiac strangulation or acute tamponade. If the injury is recognized timely, treatment is simple and effective.

Asymptomatic traumatic rupture of an intracranial dermoid cyst:A case report

BACKGROUND Previous studies reported that most of the intracranial dermoid cyst ruptures were spontaneous,and only a few were traumatic,with asymptomatic much rarer than the symptomatic ruptures.Hence,how to deal with the asymptomatic traumatic rupture of intracranial dermoid cyst remains a challenge in the clinic.CASE SUMMARY A 59-year-old man was accidentally diagnosed with intracranial dermoid cyst through a cranial computed tomography(CT)scan due to a car accident.A mixed-density lesion with fat and a calcified margin was observed in the midline of the posterior fossa,accompanied with lipid droplet drifts in brain sulci,fissures,cisterns,and ventricles.After 1 wk of conservative observation,no change was observed on the updated cranial CT scan.After 2 wk of conservative observation,magnetic resonance imaging examination confirmed that the lesion was a traumatic rupture of a posterior fossa dermoid cyst with lipid droplet drifts.As the patient exhibited no adverse symptoms throughout the 2 wk,a 6-mo follow-up visit was arranged for him instead of aggressive treatment.Nonetheless,the patient did not show any abnormal neurological symptoms in the 6 mo of follow-up visits.CONCLUSION Asymptomatic traumatic rupture of intracranial dermoid cyst could be just followed or treated conservatively rather than treated aggressively.

Spontaneous splenic rupture associated with scrub typhus: a case report

Background Scrub typhus,an acute febrile disease with mild to severe,life-threatening manifestations,potentially presents with a variety of complications,including pneumonia,acute respiratory distress syndrome,cardiac arrhyth-mias(such as atrial fibrillation),myocarditis,shock,peptic ulcer,gastrointestinal bleeding,meningitis,encephalitis,and renal failure.Of the various complications associated with scrub typhus,splenic rupture has rarely been reported,and its mechanisms are unknown.This study reports a case of scrub typhus-related spontaneous splenic rupture and identifies possible mechanisms through the gross and histopathologic findings.Case presentation A 78-year-old man presented to our emergency room with a 5-day history of fever and skin rash.On physical examination,eschar was observed on the left upper abdominal quadrant.The abdomen was not ten-der,and there was no history of trauma.The Orientia tsutsugamushi antibody titer using the indirect immunofluo-rescent antibody test was 1:640.On Day 6 of hospitalization,he complained of sudden-onset left upper abdominal quadrant pain and showed mental changes.His vital signs were a blood pressure of 70/40 mmHg,a heart rate pf 140 beats per min,and a respiratory rate of 20 breaths per min,with a temperature of 36.8℃.There were no signs of gastrointestinal bleeding,such as hematemesis,melena,or hematochezia.Grey Turner's sign was suspected during an abdominal examination.Portable ultrasonography showed retroperitoneal bleeding,so an emergency exploratory laparotomy was performed,leading to a diagnosis of hemoperitoneum due to splenic rupture and a sple-nectomy.The patient had been taking oral doxycycline(1o0 mg twice daily)for 6 days;after surgery,this was dis-continued,and intravenous azithromycin(500 mg daily)was administered.No arrhythmia associated with azithro-mycin was observed.However,renal failure with hemodialysis,persistent hyperbilirubinemia,and multiorgan failure occurred.The patient did not recover and died on the fifty-sixth day of hospitalization.Conclusions Clinicians should consider the possibility of splenic rupture in patients with scrub typhus who display sudden-onset abdominal pain and unstable vital signs.In addition,splenic capsular rupture and extra-capsular hem-orrhage are thought to be caused by splenomegaly and capsular distention resulting from red blood cell congestion in the red pulp destroying the splenic sinus.

Clinical application of laparoscopic spleen-preserving operation in traumatic spleen rupture

Objective： To evaluate the effect of laparoscopic spleen-preserving operation for traumatic spleen rupture. Methods ： From 1997 to 2003. 15 cases of traumatic spleen rupture were treated with laparoscopic spleen-preserving operation in our hospital. Nine cases had operation history in the middle and lower abdomen. ZT binding, electrocoagulation, fibrin and gelfoam tamping and suture repairing were used in patients with spleen rupture of grade I and grade Ⅱ. Combined hemostasis was used for spleen rupture of grade Ⅲ. Results： All patients did not need laparotomy during operation and no postoperative bleeding occurred. They were all cured and followed up for 3-12 months.Determination of immunoglobulinis after operation showed normal, and spleen ultrasonic examination, CT and body state evaluations were all satisfactory. Conclusions： Laparoscopy in the management of spleen trauma can be used in confirmed diagnosis and in determining the degree of spleen injury. For patients with stable vital signs laparoscopic spleen-preserving operation can be used. The laparoscopic spleen-preserving operation is safe in the treatment of traumatic spleen rupture.

Successful Treatment of Spontaneous Rupture of the Spleen by Embolization of Splenic Artery in a Patient with Acute Promyelocytic Leukaemia and COVID-19 Infection

Spontaneous rupture of the spleen (SRS) is a rare clinical entity with a potentially poor medical outcome. In most cases, SRS is caused by neoplastic disorder. Acute promyelocytic leukaemia is a rare but important cause of SRS that physicians are required to assess for. We present a 28-year-old woman with APL and COVID-19 pneumonia, who successfully underwent embolisation of the splenic artery for spontaneously occurring splenic rupture during induction chemotherapy. After the intervention the patient completed induction chemotherapy and achieved complete remission. Our case demonstrates that emergent transcatheter arterial embolisation can be lifesaving even in the unfavourable condition of a patient with severe immune deficiency.

Peritonitis secondary to ruptured splenic abscess:A grave complication of typhoid fever

Splenic abscesses are increasingly being identified,possibly due to widespread use of imaging modalities in clinical practice.The commonest clinical features are high grade fever and exclusively localised left upper quadrant abdominal pain.These symptoms are similar to most infectious diseases prevalent in the tropics,making imaging by ultrasonography or computer tomography a necessity in the diagnosis.There are reports from different geographic areas on splenic abscesses associated with typhoid fever.We reported ruptured splenic abscess presenting with peritonitis as a rare and grave complication of typhoid fever.

Spontaneous rupture of splenic hamartoma in a patient with hepatitis C virus-related cirrhosis and portal hypertension:A case report and review of the literature

Spontaneous rupture is a rare complication of splenic hamartoma. A review of the literature revealed only four such cases. To the best of our knowledge, this is the first report of spontaneous rupture of splenic hamartoma associated with liver cirrhosis and portal hypertension. A 53-year-old woman, who was followed up for aortic dissection and hepatitis C virus （HCV）-related liver cirrhosis, was referred with sudden left chest and shoulder pain. An abdominal ultrasound showed intraabdominal bleeding, and computed tomography indicated rupture of a splenic tumor. Emergent splenectomy was carried out. The postoperative course was uneventful, and the patient was discharged on the 13th postoperative day. Pathology revealed the tumor to be a ruptured splenic hamartoma. The non-tumorous splenic parenchyma revealed congestive changes. We consider that the presence of liver cirrhosis and portal hypertension are risk factors for spontaneous rupture of the splenic hamartoma.

Traumatic Rupture of the Diaphragm: Retrospective Study of 27 Cases Operated in Three Hospitals in Yaoundé (Cameroon)

Background: Traumatic ruptures of the diaphragm (TRD) are serious lesions that are often part of polytrauma. They pose a real diagnostic and therapeutic challenge in a disadvantaged environment such as ours. Methods: We conducted a descriptive observational study covering a period of 11 years in 3 referral hospitals in the city of Yaound&#233 (Cameroon). All patients who had undergone surgery for a traumatic rupture of the diaphragm between January 1, 2011 and December 31, 2020, and whose outcome within 30 days of surgery was known were included. Results: A total of 27 patients were collected. Their mean age was 36.4 ± 19.7 years. There was a strong male predominance with 22 cases (81.5%). The TRD occurred mainly after an assault (n = 9, 33.3%), was mainly on the left side (n = 25, 92.6%) and was most often part of a polytrauma (n = 17, 62.9%). The lesions associated with TRD were mainly visceral (n = 11) and bony (n = 6). The diagnosis was made preoperatively in only 13 patients (48.1%). The average length of the diaphragmatic breach was 6.4 ± 4.5 cm and a simple suture was most often used for the repair (26 cases or 96.3%). Four osteosynthesis procedures were performed at the same time as the diaphragmatic repair. The morbidity rate was 51.9%, with surgical site infection as the main complication. Six deaths (22.2%) were recorded;septic shock was the main etiology (n = 4). Conclusion: The hospital incidence of TRD remains low in our context. These lesions remain associated with significant morbidity and mortality and require a multidisciplinary approach.

Emergency laparoscopic partial splenectomy for ruptured spleen:A case report

Splenic rupture is a common consequence of blunt abdominal trauma. Emergency splenectomy is indicated when conservative management is not effective. With better understanding of the immunologic function of the spleen, surgeons have begun to perform the splenic-preserving surgery. However, it is technical challenge to perform emergency laparoscopic partial splenectomy for patient with spleen rupture. A 15-year-old male patient suffered from grade. spleen injury basing on the American association for the surgery of trauma splenic injury scale. Conservative treatment failed to success basing on the dramatically decreased hemoglobin level. During the laparoscopic exploration, we found that two individual ruptures were associated with the upper pole of spleen. An emergency laparoscopic partial splenectomy was successfully carried out. The operative time was approximate 150 min and the estimated blood loss was 200 mL. The post-operative course was uneventful and the patient was discharged on the 7th post-operative day. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

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.