Blunt abdominal trauma in Sanglah Hospital Bali, Indonesia: a study of 65 cases

Abdominal trauma is a challenge for every surgeon, whether related to diagnosis or treatment. In developing countries, the number of traumatic events associated with death makes it necessary for a study to be carried out to see the patterns and damage caused by abdominal trauma and the organs involved. Material and Method is all patients with blunt trauma of the abdomen who came to emergency unit Sanglah Hospital Bali, from January 2017 up to May 2018 that undergo laparotomy exploration were enrolled, the data were collected retrospectively using patient medical records. Results is 65 patients with blunt abdominal trauma came to the emergency department and undergoes laparotomy exploration, range of age was 4-74 year old and 75.3% of them were men. The most common injured organs were spleen and liver, both are 26 and 15 cases (40 and 23%). Another intraoperative finding are Ileum Perforation (10 cases) Left Zone II Retroperitoneal Haematoma (7 cases), and Mesenterium Rupture (5 cases). Splenectomy was the most performed procedure (26 cases). The most common cause of blunt abdominal trauma was motor vehicle accident. Hypovolemic shock was the most common clinical presentation (48 patient). The Conclusions are according to this study, men consisted 75.3% cases of blunt abdominal trauma and the range age of patients was 4-74 year old. The most common cause was motor vehicle accident. Among patients with intra-abdominal organ damage, spleen and liver were most commonly involved. About 84.6% of all patients with blunt abdominal trauma were discharged without complication and morbidity.

Ruptura esplénica espontánea como complicación en la malaria aguda grave por plasmodium falciparum / Spontaneous splenic rupture as a complication in plasmodium falciparum acute severe malaria

Se presenta el caso clínico de un paciente con rotura espontánea del bazo, como complicación grave y poco frecuente de la malaria aguda. Esta complicación puede acontecer desde la primera semana de enfermedad y su diagnóstico tardío es potencialmente fatal. Debe sospecharse en todo paciente con malaria grave, que evolutivamente presente un abdomen agudo y signos de shock hipovolémico. El manejo médico o quirúrgico dependerá de la magnitud de la ruptura y del estado hemodinámico del paciente. Se presenta el caso por la gravedad y escasa frecuencia de esta complicación(AU)

We present a clinical case of a patient with spontaneous rupture of the spleen, as a serious and uncommon complication of acute malaria. This complication can occur from the first week of illness and its late diagnosis is potentially fatal. It should be suspected in all patients with severe malaria, who evolutionarily present an acute abdomen and signs of hypovolemic shock. Medical or surgical management will depend on the extent of the rupture and hemodynamic status of the patient. The case is presented due to the severity and low frequency of this complication(AU)

Comparison of curative effect between two operation methods on treatment of the simple third-fourth grade of traumatic spleen rupture in patients with shock / 中华急诊医学杂志

Objective To study the therapeutic regimen for the simple third or fourth grade of traumatic spleen rupture in patients with hemorrhagic shock. Methods A total of 58 patients with traumatic spleen rupture complicated with hemorrhagic shock admitted between January 2012 and June 2016 were enrolled for analysis. The causes of the casualties suffering from closed abdominal injuries including 31 traffic accident, 13 falling down from a height, 8 tumbling on the ground, 2 beaten trauma and 4 other traumatic injuries. All the patients were divided into the conventional surgery group or proximal selective spleen artery embolization (PASE) group. Comparisons of surgery and postoperative relevant parameters between two groups were analyzed, and the curative effects of the two kinds of treatments was evaluated. Results There were no statistically significant difference in age, sex, degree of spleen rupture, systolic blood pressure, heart rate, and hemoglobin concentration between two groups (P＞ 0.05). The time consumed for operation (T1),the time required for systolic blood pressure recovery (T2), and the allogeneic blood volume capacity (V2) transfused in PASE group were significantly lesser than those in the conventional surgery group (P＜0.05), however there was no difference in the autologous blood volume reinfusion (V1) (P＞ 0.05). Furthermore, the incidence of fever, infection of incision, ileus, ICU treatment, time required fro intestinal function time and hospital stay in PASE group were significantly lesser than those in conventional surgery group (P＜0.05), but the incidence of left upper abdominal pain in PASE group was higher (P＜0.05). Conclusions Selective spleen artery embolization can rapidly stabilize hemodynamics, and shorten the operation time. It also can reduce the complications and allogeneic blood use, shorten recovery time and hospital stay. It is a preferential choice for treatment of traumatic spleen rupture with shock, and worth popularizing in clinical.

Splenic rupture associated with thrombocytopenic purpura caused by infectious mononucleosis. case report

ABSTRACT Introduction. Splenic rupture associated with thrombocytopenic purpura caused by infectious mononucleosis is extremely rare. The evolution of patients with infectious mononucleosis associated with Epstein-Barr virus is favorable, self-limiting and does not require specific therapeutic interventions. The symptoms are well tolerated and have a low frequency of complications. Case presentation. Female 12-year-old patient presenting with diffuse abdominal pain, distension, nausea, tegument pallor and un-quantified fever for two days. Upon admission to the emergency department, hemodynamic decompensation, purpuric lesions and ecchymosis in the limbs were observed. Laboratory and cabinet studies were carried out to confirm anemia, thrombocytopenia and splenic hematoma. Finally, an exploratory laparotomy was performed considering the possibility of hemoperitoneum. Results. The patient presented with splenomegaly, broken subcapsular hematoma, bleeding of 4000mL and accessory spleen lobe with splenic rupture. Conclusions. Spontaneous splenic rupture is a rare but possible complication of infectious diseases. However, its association with thrombocytopenic purpura is extremely rare.

RESUMEN Introducción. La rotura esplénica asociada a la presencia de purpura trombocitopénica causada por mononucleosis infecciosa es extremadamente rara; la evolución de los pacientes con mononucleosis infecciosa asociada al virus de Epstein-Barr es benigna y autolimitada y no requiere intervenciones terapéuticas específicas. El cuadro es bien tolerado y tiene una baja frecuencia de complicaciones. Presentación del caso. Paciente femenino de 12 años de edad con dos días de evolución de dolor abdominal difuso, distensión, náuseas, palidez de tegumentos y fiebre no cuantificada, quien a su ingreso al servicio de urgencias muestra datos de descompensación hemodinámica, lesiones purpúricas y manchas equimoticas en extremidades. Se realizan estudios de laboratorio y gabinete que confirman anemia, trombocitopenia y hematoma esplénico, por lo que se practica laparotomía exploradora ante la posibilidad de hemoperitoneo. Resultados. La paciente presenta esplenomegalia, hematoma subcapsular roto con sangrado de 4000mL y lóbulo accesorio de bazo con rotura esplénica. Conclusiones. La rotura espontánea del bazo es una complicación infrecuente pero posible en enfermedades infecciosas; sin embargo, su asociación a purpura trombocitopenica es extremadamente rara.

Comparison of Clinical Efficacy between Spleen Total Resection and Spleen Partial Splenectomy in Treatment of Traumatic Spleen Rupture / 现代生物医学进展

Objective:To compare the clinical efficacy and safety between spleen total resection splenectomy and spleen partial splenectomy in the treatment of patients with traumatic spleen rupture.Methods:84 cases of patients with traumatic spleen rupture from March 2013 to March 2016 were selected and divided into two groups.42 cases in the spleen total resection group were treated with spleen total resection,while the other 42 cases in the spleen partial nephrectomy group were treated with spleen partial splenectomy.The operative effect,the levels of platelet count,serum IgA,IgG,IgM,CD3 +,CD4 +,CD8 +,CD4 + / CD8 + levels before and after treatment,the incidence of complications were compared between two groups.Results:The intraoperative blood loss,exhaust time,length of hospital stay of spleen partial nephrectomy group were shorter than those of the spleen total resection group,but the operation time of research group was longer than that of the spleen total resection group (P＜0.05).The platelet count,CD8+ of spleen partial nephrectomy group were lower than those of the spleen total resection group (P＜0.05).The IgA,IgG,IgM,CD3+,CD4+,CD8+,CD4+/CD8+ of spleen partial nephrectomy group were significantly higher than those of the spleen total resection group (P＜0.05).The incidence rate of complications in the spleen partial nephrectomy group was lower than that of the spleen total resection group (P＜0.05).Conclusion:Spleen partial splenectomy was more effective than spleen total resection in the treatment of traumatic splenic rupture,which had little effect on the platelet and immune function.

Ruptura patológica del bazo como presentación clínica del linfoma difuso de células B grandes: Presentación de caso / Pathological Spleen Rupture as Clinical Presentation of Diffuse Large B-Cell Lymphoma: Case Report

La ruptura esplénica no traumática es una entidad rara; la frecuencia informada en la literatura mundial es menor del 1 %. La mayoría de los tumores malignos hematológicos pueden afectar el bazo, incluyendo varios tipos de linfomas, leucemia y tumores malignos de células plasmáticas. La neoplasia hematológica más común que afecta el bazo es el linfoma no Hodgkin, dentro de este, el subtipo difuso de células B es el más común. En este artículo se presenta el caso de ruptura esplénica patológica en una paciente de 26 años como primera manifestación clínica de un linfoma difuso de células B grandes. El diagnóstico temprano y la sospecha clínica juegan un papel vital en el desenlace, se hace una concisa revisión de la literatura disponible acerca de las definiciones y ayudas diagnósticas de este evento.

Non-traumatic splenic rupture is a rare entity; the frequency reported in the world literature is less than 1%. Most hematologic malignancies can affect the spleen, including various types of lymphomas, leukemia, and malignant plasma cell tumors. The most common haematological neoplasia affecting the spleen is Non-Hodgkin's lymphoma, among which the diffuse B-cell subtype is the most common. This article presents a case report of pathological splenic rupture in a 26-year-old patient as the first clinical manifestation of diffuse large B-cell lymphoma. Early diagnosis and clinical suspicion play a vital role in the outcome. A concise review of the available literature on the definitions and diagnostic findings of this event is made.

Ruptura atraumática del bazo: a propósito de un caso / Atraumatic splenic rupture: report of a case

Se presenta el caso de un masculino de 33 años de edad, portador de cuatro hernias discales, que fue sometido a una instrumentación, donde perdió tres litros de sangre y recibió múltiples transfusiones, al día después inició con dolor y alteración de la sensibilidad en la pierna izquierda, por lo que lo vuelven a intervenir ya que un tornillo estaba mal posicionado. Fue dado de alta. A los dos días presentó hematemesis, epistaxis e ictericia, fue llevado al hospital donde falleció por un shock hipovolémico, debido a una ruptura del bazo. La ruptura atraumática del bazo, es conocida por ser una entidad infrecuente, que puede ocurrir en ausencia de factores de riesgo como el trauma o alguna patología de fondo.

Case of a 33 years old male bearing four discs hernias who went through surgical instrumentation, where he lost 3 liters of blood and received multiple transfusions. Next day reported pain and sensitivity alteration on the left leg; returns to surgery because one bold was not well positioned. Released from the hospital, and two days later returned with hematemesis, epistaxis, and jaundice, went back to the hospital where he died from a hypovolemic shock due to a spleen rupture. The non-traumatic spleen rupture is very infrequent in absence of risk factors, such as trauma or a base pathology.

Hemangioblastoma cereberoloso en el síndrome de von Hippel-Lindau, como causa de muerte: reporte de un caso / Case report: cereberoloso in Von Hippel-Lindau disease, hemangioblastoma cause of death

El síndrome de von Hippel-Lindau es una enfermedad caracterizada por el desarrollo de tumores como hemangioblastomas del sistema nervioso central y de la retina, quistes renales, hepáticos y pancreáticos; carcinoma renal de células claras, feocromocitoma, así como adenomas en el oído interno, la nariz y la laringe. En la mayoría de los casos hay un antecedente familiar positivo del síndrome 8. A continuación se presenta el caso de una femenina de 35 años de edad, sin antecedentes personales patológicos conocidos, con antecedente familiar positivo por la enfermedad de von Hippel-Lindau. Según la historia de sus familiares, la mujer presentaba “ataques de rigidez” de dos semanas de evolución, posterior a uno de estos ataques fue atendida por paramédicos quienes la declararon fallecida. Según la autopsia médico legal se diagnosticó una hidrocefalia obstructiva secundaria a hemangioma cerebeloso y hallazgos compatibles con el Síndrome de von Hippel-Lindau. El objetivo de este artículo es resaltar los hallazgos postmortem de esta entidad y su relación con la causa de la muerte.

Von Hippel-Lindau syndrome is characterized by tumors as central nervous system and retinal hemangioblastomas; renal, liver and pancreas cysts; clear cells renal carcinoma, pheochromocytoma and adenomas of the ear, nose and larynx. In most cases there is a positive family history of the syndrome 8. The follow case is about a female how was 35 years old without known medical history. She had a positive family history of von Hippel-Lindau, and her family told us about she had “stiffness attacks” and two weeks later had another stiffness attack so it was treated by paramedics who declared her dead. In agreement with the forensic autopsy findings the diagnosis was hydrocephalus induced by brain stem hemangioma and the findings were compatible with von Hippel-Lindau. The aim of this article is to highlight the most important postmortem findings of this syndrome and its relation to the cause of death.

Diagnostic value of multi-slice spiral CT for emergency traumatic liver and spleen rupture / 西安交通大学学报(医学版)

Objective To evaluate the diagnostic value of multi-slice spiral CT (MSCT)for traumatic spleen and liver rupture.Methods We made a retrospective analysis of 140 cases of liver and spleen injury with clinical manifestations confirmed by operation.MSCT examination results and clinical data were compared.Results Of the 140 cases,male patients outnumbered female ones,and the peak age was 10 - 30 years old.The injuries were most commonly attributed to traffic accident and falling.There were 69 (49%)cases of spleen injury,5 1 (36%) cases of liver injury,and 20 (14%)cases of both.Liver and spleen injuries showed on MSCT examination were liver and spleen laceration, hematoma within the liver and spleen as well as hematoma beneath the envelop. Conclusion MSCT has an important diagnostic value for traumatic liver and spleen rupture and thus can guide clinical treatment choice.

Ectopic Splenic Autotransplantation after splenic rupture and splenic resection: our experience in 15 patients / 中华肝胆外科杂志

Objective To study the clinical characteristics and to summarize our experience in the diagnosis and treatment of ectopic splenic autotransplantation (ESAP) many years after splenic rupture and splenectomy.Methods The clinical data of 15 patients with ESAP who were treated in the People's Hospital of Zhengzhou from January 1998 to January 2013 were retrospectively analyzed.Results Of the 15 patients,2 patients presented with intestinal obstruction due to the ectopic splenic tissues and required partial resection of small intestine.In 5 patients,the ectopic splenic tissues were in the greater omentum which required resection of part or the whole of the greater omentum.In 4 patients,the ectopic splenic tissues were in the mesentery which required partial or total resection of the tissues.The ectopic tissues were in the pelvis in 3 patients and resection of the left fallopian tube was carried out in 2 patients and resection of the pelvic tissues in 1 patient.In 1 patient the diagnosis was made under laparoscopic biopsy,thus avoiding open surgery.Three patients had multiple implanted sites for these ectopic splenic tissues.Conclusions ESAP is an uncommon disease and it has no clinical characteristics.It is easy to confuse the condition with metastatic deposits.A diagnosis could be made only by combining the history with magnetic resonance imaging,or 99mTc study of red blood cells,or laparoscopic exploration and biopsy.

Clinical application of emergency interventional embolization in treating traumatic spleen rupture / 介入放射学杂志

Objective To assess the value of emergency interventional embolization in treating traumatic spleen rupture. Methods A total of 74 patients with traumatic spleen rupture, who were encountered at authors’ hospital during the period from July 2007 to July 2013, were enrolled in this study. The clinical data were retrospectively analyzed. The patients were divided into embolization group (n = 38) and surgery group (n = 36). Interventional splenic artery embolization was carried out in the patients of the embolization group, and surgical repair was employed in the patients of the surgery group. The operation time, the amount of blood loss during the procedure, the hospitalization days, the preservation rate of the spleen and the occurrence of procedure- related adverse events were recorded, and the results were compared between the two groups. Results No significant difference in the operation time existed between the two groups (P = 0.061). The amount of blood loss during the procedure, the hospitalization days and the occurrence of procedure- related adverse events in the embolization group were significantly lower than those in the surgery group (P < 0.05), while the preservation rate of the spleen of the embolization group was significantly higher than that of the surgery group (P = 0.026). Conclusion Emergency interventional embolization is a safe procedure for the treatment of traumatic spleen rupture, this technique can improve the preservation rate of the spleen when compared with traditional surgical repair treatment.

Observation of clinical curative effect of operation of splenic salvage on traumatic ruptured spleen using microwave coagulator / 国际外科学杂志

Objective To investigate the clinical effect and safety of spleen-preserving surgery by microwave tissue coagulation (MTC) therapy.Methods Retrospectively analyzed the clinical data of 45 cases undergoing spleen retaining surgery by MTC therapy (observation group) and comparative study was used on another 45 cases experiencing splenectomy (comparative group),clinical effect and complications were compared.All cases were patients from Jan.2010 to Jun.2013.Results All cases were cured.Hospitalization of observation group is obviously shorter than that of comparative group(P =0.007).The rate of complication in observation group(4.44％) is lower than that in comparative group (20.00％),but the time and amount of bleeding in operation of observation group is much more than that of comparative group.Conclusion MTC can effectively guarantee patients safety,shorten hospital stay,and be worthy of popularization.

Emergency CT diagnosis of spleen raptures in 96 cases / 中国基层医药

Objective To improve the accuracy rate of emergency CT diagnosis of spleen rupture.Methods 96 cases of CT diagnosis of spleen rupture were retrospectively analyzed.Results 96 cases of CT diagnosis of spleen rupture were retrospectively analyzed 96 cases of CT diagnosis of spleen rupture.87 cases were confirmed by sorgerg or consrvalion treatment review.diayrosis rate was 90%.Conclusion Hemathorax,rib fracture,hepatorrhexis support the diagnosis.

Ruptured Solitary Splenic Metastasis of Gastric Cancer after Gastric Cancer Operation

Solitary malignant splenic metastasis is uncommon and usually occurs in association with widely disseminated metastatic disease. Splenic metastasis usually occurs late in the disease course, with widespread involvement of other organs and rarely shows any presenting symptoms. Virtually all primary tumors have been known to metastasize to the spleen. The common ones include melanoma, lung, breast and ovary cancer, but metastasis from gastric cancer is very rare. When solitary spleen metastasis is suspected in a clinical setting, aggressive treatment is indicated such as splenectomy followed by combined modality treatment to prevent dissemination of the disease. We experienced a case of solitary spleen metastasis and rupture after gastric cancer operation and reviewed the associated literatures.

Analysis of the diagnosis and treatment of 317 cases of traumatic rupture of spleen / 中国普通外科杂志

ObjectiveTo discuss the diagnosis and treatment of rupture of spleen in a base-level hospital with limited conditions. MethodsThe clinical data, diagnosis of bleeding by ultrasound, and results of (nonoperative) and operative treatment of 317 patients with rupture of spleen in Vila Central Hospital of the (Republic) of Vanuatu were retrospectively analyzed. ResultsUltrasound diagnosed 30 patients with (subcapsular) hemorrhage and 287 patients with true rupture of spleen. Based on ultrasound results, (conservative) treatment was used for 29 patients and 288 patients underwent operation. Conclusions(Ultrasonography) had a high positive diagnostic rate for rupture of spleen, and the diagnosis of bleeding volume was consistent with the findings at operation. The findings on ultrasonography can be considered in selection of cases with appropriate indications for splenectomy. Ultrasonography is an effective method for use in the (treatment) of rupture of spleen.

Diagnosis and treatment of traumatic splenic rupture: a report of 184 cases / 中国普通外科杂志

Objective To summarize our experiences in the diagnosis and treatment of traumatic splenic rupture (TSR), in order to improve the diagnosis and treatment effect of TSR. Methods Retrospective (analysis) of the diagnosis and treatment of 184 patients with traumatic splenic rupture in recent 9 years was made. Results The preoperative correct diagnosis rate was 96.7% and was established on the history of (injury), clinical presentation, abdominal paracentesis, abdominal ultrasonography and CT. All the 34 of (patients) treated nonoperatively were cured. Of the 150 patients treated by operation, two died during operation and 148 patients were cured. Conclusions Combination of obtaining a detailed history of injury, physical examination, abdominal paracentesis, abdominal ultrasonography and CT can improve the accuracy rate of (preoperative) diagnosis.Under the ensurrance of the safety of the patients' life, preservation of the spleen should be performed if possible, especially for children. Both splenorrhaphy with or without ligation of splenic artery are simple, safe and effective methods to salvage the spleen.

Study of the fluid infusion model on the non-operative management of spleen rupture / 中国普通外科杂志

Objective To compare the effect of two different fluid infusion models in the non-operative management of spleen rupture .Methods The clinical data of 46 cases of spleen rupture with non-operative management from 1995 to 2001 were analyzed retrospectively. Results In the non-operative management of spleen rupture, patients received continuous but rather slow fluid infusion had higher successful treatment rate(95.24%) and less intra- abdominal bleeding than those in patients received rapid fluid infusion (91.02%) . Conclusions In the non- opeative management of spleen rupture, continuous but rather slow fluid infusion model is superior to traditional rapid fluid infusion.

Spleen Rupture in Congenital Afibrinogenemia

Congenital afibrinogenemia is a rare disorder that refers to a congenital lack of production of fibrinogen, a key component of the hemostatic system. Bleeding manifestations of congenital afibrinogenemia vary in severity from mild to catastrophic. This is a case report of splenic rupture occurred in an eight-year-old boy with congenital afibrinogenemia. A conservative treatment was carried out with perfusion of cryoprecipitate and purified virally inactivated fibrinogen concentrates and splenectomy was avoided.

The Diagnostic Value of Contrast-enhanced CT Scans for Traumatic Splenic Rupture / 实用放射学杂志

Objective To evaluate the diagnostic value of contrast-enhanced CT scans in diagnosis of traumatic splenic rupture. Methods The findings of unenhanced and contrast-enhanced CT scans of 34 cases with traumatic splenic rupture confirmed by operation were retrospectively reviewed. Results Of the 34 patients, the diagnoses of splenic rupture on unenhanced CT scans were certain in 23 patients and uncertain in 6 patients. No abnormalities were found in 5 patients(sensitivity 85.3%, specificity 67.6%). After intravenous administration of contrast material, all of the patients were diagnosed as splenic rupture(sensitivity 100%,specificity 100%).Conclusion Contrast-enhanced CT is important in diagnosis of traumatic splenic rupture and can obviously improve the diagnostic accuracy. It provides reliable information for clinical treatment.