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Ugeskrift For Laeger Mar 2024Atraumatic splenic rupture (AMR) is a life-threatening condition with a wide range of aetiologies, and it may present with a vague symptomatology. Therefore, AMR can be... (Review)
Review
Atraumatic splenic rupture (AMR) is a life-threatening condition with a wide range of aetiologies, and it may present with a vague symptomatology. Therefore, AMR can be diagnostically challenging. In this review, we wish to focus on the fact that guidelines only exist for traumatic splenic rupture although they may be applicable for AMR too. In addition, a stringent ABCDE approach for clinical examination may early and reliable diagnose the patients and guide further imaging examination and treatment.
Topics: Humans; Physical Examination; Rupture, Spontaneous; Splenic Rupture
PubMed: 38533862
DOI: 10.61409/V05230328 -
Cureus Dec 2023Splenic artery aneurysms are rare and usually asymptomatic, with a high risk of mortality once they get ruptured. A case report of a spontaneous rupture of a splenic...
Splenic artery aneurysms are rare and usually asymptomatic, with a high risk of mortality once they get ruptured. A case report of a spontaneous rupture of a splenic artery aneurysm in a 65-year-old female is reported. The patient presented in the emergency department with abdominal pain, nausea, and vomiting, followed by syncope. A contrast-enhanced CT scan was performed and showed a splenic artery aneurysm measuring 40 × 35 mm surrounded by a hematoma. The patient was submitted to emergency laparotomy with ligation of the splenic artery, aneurysm resection, and splenectomy. There were no surgical complications, and the patient was discharged home on the fifth postoperative day. A rupture of a splenic aneurysm is a rare condition with a high mortality rate and should be considered a differential diagnosis in a patient with abdominal pain and hemodynamic instability.
PubMed: 38249169
DOI: 10.7759/cureus.50937 -
Revista Espanola de Enfermedades... Nov 2023EBV is a gammaherpesvirus that infects a large fraction of the human population. Many people infected with the virus remain asymptomatic. The most common clinical...
EBV is a gammaherpesvirus that infects a large fraction of the human population. Many people infected with the virus remain asymptomatic. The most common clinical manifestation of EBV is linked to infectious mononucleosis (IM). IM usually resolves over a period of weeks or months without sequelae. However, splenic rupture is another rare complication of IM. Splenic rupture of this case occur without any traumatic cause.
PubMed: 37929947
DOI: 10.17235/reed.2023.9998/2023 -
International Journal of Surgery Case... Sep 2023Isolated splenic peliosis is an extremely rare condition. The associations of splenic peliosis with various infections, medications, and conditions have unclear...
INTRODUCTION AND IMPORTANCE
Isolated splenic peliosis is an extremely rare condition. The associations of splenic peliosis with various infections, medications, and conditions have unclear significance. We present three patients from the past twenty years with spontaneous splenic rupture due to peliosis, two of whom had hematologic malignancy, to draw attention to a possible correlation.
CASE PRESENTATION
A 31-year-old male with essential thrombocytopenia and antiphospholipid-antibody syndrome presented with worsening abdominal pain and hypotension. The patient denied any trauma. Computed-tomography demonstrated hemoperitoneum and splenic rupture with innumerable blood-filled splenic cysts. An uncomplicated emergency open splenectomy was performed with shed-blood reinfusion. The patient was discharged on postoperative day five. The patient developed acute myelogenous leukemia and died six years later. A 44-year-old otherwise healthy male presented with left upper-quadrant and shoulder pain without reported trauma. Computed-tomography (CT) imaging revealed splenomegaly, multiple splenic cystic lesions, and free intraperitoneal blood. A laparoscopic splenectomy, complicated by a pancreatic leak that was managed with a drain, was performed. The patient was discharged on postoperative day three and was well at 37 months follow-up. A 78-year-old male with splenomegaly and chronic anemia on warfarin for atrial fibrillation presented in shock with a distended abdomen after falling from a standing height. The patient was resuscitated with two units of packed red blood cells and underwent emergent abdominal exploration. The spleen was ruptured. An open splenectomy was performed and four liters of intraperitoneal blood were evacuated. Pathology confirmed splenic peliosis and historic diffuse large B-cell lymphoma. The patient had an excellent response to chemotherapy but died 12 years later.
CLINICAL DISCUSSION
Splenic peliosis is a rare vascular phenomenon of unclear etiology. Several toxic and pharmaceutical agents have been associated with spontaneous splenic rupture in patients with peliosis. There are also a number of reported patients who were noted to have hematologic disorders, suggestive of a potential association to the pathophysiology of peliosis.
CONCLUSION
Based on our clinical experience and focused literature review, it appears likely that there is a relationship between splenic peliosis and hematologic malignancy.
PubMed: 37633196
DOI: 10.1016/j.ijscr.2023.108676 -
Journal of the Belgian Society of... 2024Atraumatic splenic rupture is a rare but life-threatening complication of infectious mononucleosis.
Atraumatic splenic rupture is a rare but life-threatening complication of infectious mononucleosis.
PubMed: 38523728
DOI: 10.5334/jbsr.3536 -
Emergency Medicine International 2023The aim of this study is to evaluate the efficacy of endovascular treatment for nondissected diseases of the ascending aorta. . PubMed, Embase, and SciELO. . In this... (Review)
Review
OBJECTIVE
The aim of this study is to evaluate the efficacy of endovascular treatment for nondissected diseases of the ascending aorta. . PubMed, Embase, and SciELO. . In this study, we conducted a search on the PubMed, Embase, and SciELO databases for all cases of ascending aortic endovascular repair included in the literature published between January 2007 and July 2023, excluding type A aortic dissection. We reviewed 56 case reports and 7 observational studies included in this study, assessing the techniques, equipment, procedural steps, and results. We summarized the age, complications, follow-up time, and access route.
RESULTS
This study includes 63 articles reporting 105 patients (mean age: 64.96 ± 17.08 years) who received endovascular repair for nondissected ascending aortic disease. The types of disease include aneurysm ( = 16), pseudoaneurysm ( = 71), penetrating aortic ulcer ( = 10), intramural hematoma ( = 2), thrombosis ( = 2), iatrogenic coarctation ( = 1), and rupture of the aorta ( = 3). The success rate of surgery is 99.05% (104/105). Complications include endoleak (10.48%, 11/105), stroke (5.71%, 6/105), postoperative infection (1.91%, 2/105), acute renal failure (0.95%, 1/105), aortic rupture (0.95%, 1/105), thrombosis (0.95%, 1/105), and splenic infarction (0.95%, 1/105). Five patients required conversion to open surgery, two patients underwent endovascular reintervention, and four of these five patients underwent surgery due to endoleak. Early mortality was 2.86% (3/105).
CONCLUSION
While the viability and results of endovascular repair for the treatment of ascending aortic disease are acknowledged in some circumstances, further research is needed to determine the safety and effectiveness of endovascular treatment for ascending aortic disease.
PubMed: 37767197
DOI: 10.1155/2023/5592622 -
Cureus Sep 2023Splenic rupture of all causes is a potentially life-threatening event for patients. The infrequency of atraumatic splenic rupture (ASR) poses a significant diagnostic...
Splenic rupture of all causes is a potentially life-threatening event for patients. The infrequency of atraumatic splenic rupture (ASR) poses a significant diagnostic challenge due to atypical findings. ASR is commonly due to a spleen with an underlying disease process such as malignancy, infection, coagulopathies, or neoplasms. However, ASR without an identifiable cause is rare and poses further complexity. In this case, a 57-year-old woman with a history of hypertension presented to the emergency department complaining of chest pain and was found to have a splenic hematoma. She underwent splenic artery embolization due to her continued hemodynamic instability. The patient was ultimately treated with a splenectomy, as embolization was unsuccessful. Gross pathology revealed no underlying disease processes, nodules, or masses. Splenic hemorrhage due to atraumatic rupture of the spleen is rare and without known pathology. The case illustrates the need for providers to have high clinical suspicion of such a diagnosis to stabilize and surgically manage these patients. Few instances of ASR without an identifiable cause are found in medical literature, and further knowledge of the subject is needed.
PubMed: 37720112
DOI: 10.7759/cureus.45364