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Case Reports in Women's Health Jun 2024Splenic hydatid cysts are caused by the species and rarely occur in pregnancy. This case report describes the management of a 29-year-old pregnant woman with a large...
Splenic hydatid cysts are caused by the species and rarely occur in pregnancy. This case report describes the management of a 29-year-old pregnant woman with a large (11 × 8.7 × 10.5 cm) splenic hydatid cyst. The cyst had been identified before she became pregnant by her general practitioner with imaging investigations undertaken for her persistent left upper abdominal pain. The patient also had laboratory investigations which were positive for echinococcosis species. Hydatid splenic cysts are very rare and even more so in pregnancy. Risk of splenic cyst rupture exists, and rupture has significant risk of maternal and perinatal morbidity and mortality. Among the few case reports in the literature there is no clear consensus on conservative or surgical management during pregnancy and no clear guidelines for intrapartum care or delivery. The case report reviews the literature on splenic hydatid cyst disease in pregnancy and explores the management and outcome of this patient through her fourth pregnancy, which resulted in an uncomplicated vaginal birth.
PubMed: 38808175
DOI: 10.1016/j.crwh.2024.e00611 -
International Journal of Surgery Case... May 2024Blunt abdominal trauma is one of the most common reasons for emergency department visits, and spleen and splenic vasculature is involved variably in those cases. Splenic...
INTRODUCTION AND IMPORTANCE
Blunt abdominal trauma is one of the most common reasons for emergency department visits, and spleen and splenic vasculature is involved variably in those cases. Splenic artery pseudoaneurysm formation is one complication with potentially devastating consequences. Early detection and management are of paramount importance given its potential fatality. Management includes open repair with or without splenectomy, and endovascular approach. The minimally invasive endovascular treatment offers earlier recovery, preserved splenic function, and positive outcomes. We report a case of delayed presentation of a large splenic artery pseudoaneurysm after blunt abdominal trauma, managed using endovascular intervention.
CASE PRESENTATION
A 45-year-old male presented 10 days after being involved in a pedestrian accident with blunt abdominal trauma resulting in a large splenic artery pseudoaneurysm. After multidisciplinary discussion, the decision was to take him for endovascular treatment. The patient recovered very well and was discharged two days later and followed up in an outpatient setting. Over a year, he became symptom free, and demonstrated radiological finding of shrinking pseudoaneurysm.
CLINICAL DISCUSSION
Pseudoaneurysms of visceral arteries are repaired regardless of their size per society of vascular surgery guidelines. Larger ones are at higher risk of rupture and are associated with high mortality. When discovered, treatment plans should be readily discussed, and undertaken. In our case, the patient had a 6.5 cm splenic artery pseudoaneurysm, and a multidisciplinary meeting was conducted and concluded that endovascular treatment would be the best modality to start with, with surgical option as a backup in a hybrid room setting.
CONCLUSION
Blunt abdominal trauma can present with overt symptoms of internal organ injury; however, some might be missed and need high index of suspicion and therefore further testing and imaging. Splenic artery pseudoaneurysms can expand and rupture in delayed presentation, early detection and management is of paramount importance. Endovascular treatment represents an excellent modality, with minimal invasive nature, faster recovery, and early return to daily activity with preserved splenic function.
PubMed: 38795411
DOI: 10.1016/j.ijscr.2024.109799 -
Journal of Clinical Medicine May 2024In treatment of aneurysms (SAAs) and pseudoaneurysms (SAPs) of the splenic artery, endovascular coil embolization is the approach most commonly used as it is minimally... (Review)
Review
In treatment of aneurysms (SAAs) and pseudoaneurysms (SAPs) of the splenic artery, endovascular coil embolization is the approach most commonly used as it is minimally invasive and safe. However, it carries a significant rate of primary failure (up to 30%) and might be complicated by splenic infarction. The use of stent grafts might represent a valuable alternative when specific anatomical criteria are respected. We report a comprehensive review on technical and clinical outcomes achieved in this setting. We performed a comprehensive review of the literature through the MedLine and Cochrane databases (from January 2000 to December 2023) on reported cases of stenting for SAAs and SAPs. Outcomes of interest were clinical and technical success and related complications. The durability of the procedure in the long-term was also investigated. Eighteen papers were included in the analysis, totalling 41 patients (n = 20 male 48.8%, mean age 55.5, range 32-82 years; n = 31, 75.6% SAAs). Mean aneurysm diameter in non-ruptured cases was 35 mm (range 20-67 mm), and most lesions were detected at the proximal third of the splenic artery. Stent grafting was performed in an emergent setting in n = 10 (24.3%) cases, achieving immediate clinical and technical success rate in 90.2% (n = 37) of patients regardless of the type of stent-graft used. There were no procedure-related deaths, but one patient died in-hospital from septic shock and n = 2 (4.9%) patients experienced splenic infarction. At the last available follow-up, the complete exclusion of the aneurysm was confirmed in 87.8% of cases (n = 36/41), while no cases of aneurysm growing nor endoleak were reported. None of the patients required re-intervention during follow-up. When specific anatomical criteria are respected, endovascular repair of SAAs and SAAPs using stent grafts appears to be safe and effective, and seems to display a potential advantage in respect to simple coil embolization, preserving the patient from the risk of end-organ ischemia.
PubMed: 38792344
DOI: 10.3390/jcm13102802 -
International Journal of Surgery Case... May 2024Recently, the utilization of surgical stabilization of rib fractures (SSRF) with video-assisted thoracoscopic surgery (VATS) has been increasing owing to its...
INTRODUCTION
Recently, the utilization of surgical stabilization of rib fractures (SSRF) with video-assisted thoracoscopic surgery (VATS) has been increasing owing to its effectiveness. The present report describes the case of a patient who underwent SSRF with VATS and subsequently developed a splenic rupture that was speculated to be related to intrathoracic manipulation during surgery.
PRESENTATION OF CASE
A 62-year-old male patient sustained injuries from a fallen festival car over his thoracoabdominal zone and was diagnosed with bilateral multiple rib fractures and burst fractures of the twelfth thoracic and first lumbar vertebrae. The patient underwent SSRF with VATS. Following surgery, the patient went into hemorrhagic shock due to a splenic rupture, necessitating an emergency open splenectomy.
DISCUSSION
Despite no initial detection of splenic injury on contrast-enhanced CT, it is possible that a slight splenic injury existed at the time of the initial diagnosis. Moreover, during surgery, additional external forces may have been applied to the spleen due to positional changes, such as shifting to the lateral position or retracting the diaphragm using forceps; these manipulations could have potentially caused a slight splenic injury, possibly leading to splenic rupture.
CONCLUSION
When performing SSRF through VATS, it is important to recognize that manipulation and traction of the diaphragm could potentially cause splenic rupture, even if a slight force is applied. Therefore, the diaphragm should be evaluated without traction and manipulation whenever possible.
PubMed: 38772241
DOI: 10.1016/j.ijscr.2024.109758 -
Frontiers in Oncology 2024Spontaneous splenic rupture is an extremely rare occurrence, often attributed to tumorous pathologies. Among these, primary splenic angiosarcoma stands as a malignancy...
Spontaneous splenic rupture is an extremely rare occurrence, often attributed to tumorous pathologies. Among these, primary splenic angiosarcoma stands as a malignancy arising from the endothelial cells within the spleen. While sporadic cases have been reported globally, there remains a lack of comprehensive consensus on standardized approaches for diagnosis and treatment. We report a case of an 83-year-old male who underwent emergency enhanced CT due to sudden shock, revealing significant intra-abdominal fluid accumulation. Emergency surgery revealed splenic rupture necessitating splenectomy. Histopathological examination confirmed the diagnosis of splenic angiosarcoma. Despite successful surgery, the patient succumbed to severe complications two weeks postoperatively.
PubMed: 38756665
DOI: 10.3389/fonc.2024.1366554 -
The Journal of International Medical... May 2024Traumatic splenic rupture is rare in pregnant women; and multiple venous thromboses of the portal vein system, inferior vena cava and ovarian vein after caesarean...
Traumatic splenic rupture is rare in pregnant women; and multiple venous thromboses of the portal vein system, inferior vena cava and ovarian vein after caesarean section and splenectomy for splenic rupture has not been previously reported. This case report describes a case of multiple venous thromboses after caesarean section and splenectomy for traumatic splenic rupture in late pregnancy. A 34-year-old G3P1 female presented with abdominal trauma at 33 weeks of gestation. After diagnosis of splenic rupture, she underwent an emergency caesarean section and splenectomy. Multiple venous thromboses developed during the recovery period. The patient eventually recovered after anticoagulation therapy with low-molecular-weight heparin and warfarin. These findings suggest that in patients that have had a caesarean section and a splenectomy, which together might further increase the risk of venous thrombosis, any abdominal pain should be thoroughly investigated and thrombosis should be ruled out, including the possibility of multiple venous thromboses. Anticoagulant therapy could be extended after the surgery.
Topics: Humans; Female; Splenectomy; Venous Thrombosis; Adult; Splenic Rupture; Pregnancy; Cesarean Section; Postpartum Period; Anticoagulants; Heparin, Low-Molecular-Weight; Warfarin
PubMed: 38749907
DOI: 10.1177/03000605241255507 -
Cureus Apr 2024A spontaneous rupture of the spleen during pregnancy or post-delivery is an exceptionally rare but potentially fatal maternal complication that poses a significant...
A spontaneous rupture of the spleen during pregnancy or post-delivery is an exceptionally rare but potentially fatal maternal complication that poses a significant challenge in diagnosis and management. Herewith, we present a case of a 31-year-old female patient who experienced a spontaneous splenic rupture following a singleton vaginal delivery. Despite lacking any history of trauma or a predisposing factor, she developed symptoms of dizziness and postpartum abdominal pain, progressing rapidly to unconsciousness. Urgent abdominal ultrasound revealed significant intraperitoneal bleeding with a large peri-splenic hematoma, necessitating emergency exploratory laparotomy. Histopathological examination of a frozen section ruled out malignancy, and thus, a complete splenectomy was done, which confirmed the diagnosis of spontaneous splenic rupture. This case emphasizes the importance of close monitoring of all postpartum women, even those with low-risk pregnancies, for the early detection of any complication. Healthcare providers should maintain a high index of suspicion for rare but potentially life-threatening events to ensure timely intervention and optimal outcomes.
PubMed: 38745793
DOI: 10.7759/cureus.58246 -
Cureus Apr 2024is a parasite that invades erythrocytes inducing hemolysis. It presents with a variety of non-specific symptoms that can be mistaken for other illnesses. A rare...
is a parasite that invades erythrocytes inducing hemolysis. It presents with a variety of non-specific symptoms that can be mistaken for other illnesses. A rare manifestation of babesiosis is splenic rupture, generally seen in a younger, healthier population with low parasitemia, which can be treated conservatively depending on the grade and clinical condition. This case describes an elderly male with multiple comorbidities who is an avid hiker in the Northern Ohio and Western Pennsylvania areas presenting with a spontaneous American Association for the Surgery of Trauma (AAST) grade V splenic rupture requiring emergent splenectomy. Subsequent re-admission was required to diagnose babesiosis, which was managed with pharmacotherapy and plasmapheresis. In lieu of other identifiable etiologies, patients with atraumatic splenic rupture in an endemic area should be screened for possible parasitic infections.
PubMed: 38707037
DOI: 10.7759/cureus.57659 -
World Journal of Gastrointestinal... Apr 2024Splenic 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 BS-associated...
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 BS-associated 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.
PubMed: 38690059
DOI: 10.4240/wjgs.v16.i4.1184 -
Bulletin of Emergency and Trauma 2024This study aimed to evaluate the outcome and risk factors in operative and non-operative management of splenic injury.
OBJECTIVE
This study aimed to evaluate the outcome and risk factors in operative and non-operative management of splenic injury.
METHODS
This cross-sectional study was conducted on patients with traumatic splenic injuries who were hospitalized in Kashani Hospital (Isfahan, Iran) from 2017 to 2019. The studied variables were extracted from the medical records of the enrolled participants. The outcomes such as mortality complications and risk factors were compared based on treatment methods.
RESULTS
A total of 240 patients were investigated. The mean age of the patients was 29.8±12.2, with 180 (77.5%) patients being men. 154 (64.2%) patients underwent operative treatment. The mortality rate was 18.9% and 4.6% among operative and non-operative groups (<0.001). Complications were observed in 11.5% and 46.1% of non-operative and operative groups, respectively (<0.001). Operative treatment inversely correlated with mortality (<0.001) and complications (<0.05). Splenic injury severity was correlated positively with mortality (<0.001) and negatively with complications (<0.001). Unstable hemodynamic status was positively correlated with complications (<0.001). Age had a positive correlation with mortality (<0.001) and complications (<0.001). Male sex had a negative correlation with complications (<0.001). GCS score and admission were positively correlated with mortality (<0.001). There was no statistically significant correlation between correlated injuries and outcomes (≥0.05).
CONCLUSION
Patients who received surgery had higher rates of mortality and complications. However, after controlling for confounders, operative treatment was found to be inversely correlated with mortality and complications.
PubMed: 38689793
DOI: 10.30476/BEAT.2024.101350.1489