Infarto esplénico por exposición a la altura

Introducción: El infarto esplénico es una de las enfermedades que se presentan secundarias al fallo de aclimatación. En la literatura revisada se relaciona con la presencia de un rasgo sicklémico y desde la década del 50 se tienen reportes de casos a nivel mundial. Objetivo: Describir un caso de infarto esplénico por exposición a la altura. Presentación del caso: Se expuso un paciente que presentó un infarto esplénico después de su exposición a la altura, el cual fue intervenido quirúrgicamente y se presentaron un grupo de complicaciones en el posoperatorio. En la literatura internacional esta enfermedad se relaciona con la presencia de la hemoglobina S, lo cual no concuerda con nuestro paciente, a pesar de no ser el estudio de elección. Sus antecedentes pudieron contribuir a la ocurrencia de esta complicación. Las complicaciones que aparecieron en el posoperatorio coincidieron con las comentadas por otros autores. Conclusiones: El infarto esplénico por exposición a la altura es una complicación que debe tenerse en cuenta cuando se presenta un paciente a su llegada a este ecosistema, aparece con dolor abdominal, donde la inmediatez en la conducta es fundamental para evitar complicaciones de mayor gravedad.

Introduction: Splenic infarction is one of the diseases that occur secondary to failure of acclimatization. In the reviewed literature, it is related to the presence of a sicklemic trait and since the 1950s there have been case reports worldwide. Objective: To describe a case of splenic infarction due to exposure to high altitude. Case report: We report the case of a patient who had a splenic infarct after exposure to high altitude. This patient, who underwent surgery, had a group of complications during the postoperative period. The international literature associates this disease with the presence of hemoglobin S, which does not coincide with the case of our patient, despite not being the study of choice. His history could have contributed to the occurrence of this complication. Those that appeared in the postoperative period did agree with those commented by other authors. Conclusions: Splenic infarction due to exposure to altitude is a complication that must be taken into account when a patient has abdominal pain. Immediacy in behavior is essential to avoid more serious complications.

Infarto esplénico masivo secundario a compresión de vasos esplénicos por un tumor quístico de páncreas / Massive splenic infarction secondary to compression of splenic vessels by a pancreatic cystic tumor

RESUMEN Los infartos esplénicos son una causa infrecuente de dolor abdominal. Son causados por una amplia variedad de patologías. Presentamos el caso de un paciente en el que se hizo diagnóstico de infarto esplénico masivo secundario a una compresión extrínseca de un tumor quístico de páncreas.

ABSTRACT Splenic infarctions, a rare cause of abdominal pain, may be due to several conditions. We report the case of a male patient with a massive splenic infarction secondary to extrinsic compression from a pancreatic cystic tumor.

Successful management of brain abscess and paradoxical embolization caused by huge pulmonary arteriovenous malformation: a case report / 中国医师杂志

Objective:The purpose of this case report is to improve the understanding of pulmonary arteriovenous malformation (PAVM) and its related complications by reviewing case data and literature.Methods:A case of huge PAVM complicated with brain abscess and paradoxical embolization of liver, spleen and kidney is reported, and then we summarize its clinical characteristics, diagnosis and treatment, and review the relevant references.Results:Brain abscess and paradoxical embolization are the most common complications of PAVM. The diagnosis and process of this patient was timely and clear. The patient received interventional embolization for PAVM and achieved good results.Conclusions:PAVM can cause brain abscess and paradoxical embolization. We should be vigilant to avoid missed diagnosis and misdiagnosis.

Tuberculosis ileocecal: a propósito de un caso / Ileocecal tuberculosis: A case report

Resumen La tuberculosis es una enfermedad de importancia en la salud pública a nivel mundial, con una alta incidencia a nivel del territorio colombiano. Principalmente, afecta el parénquima pulmonar; sin embargo, en un porcentaje elevado de casos se diagnostica en su forma extrapulmonar y el tracto gastrointestinal es uno de los sitios más frecuentes. Así mismo, la región ileocecal y el íleon terminal son las regiones con más predilección por la bacteria Mycobaterium tuberculosis. Las manifestaciones en esta rara presentación de la enfermedad están dadas por dolor abdominal y sensación de masa principalmente, lesiones ulcerosas en la mucosa intestinal y hallazgos histológicos correspondientes a granulomas caseificantes de gran tamaño y de morfología confluente, que se diferencian de otras entidades como la enfermedad de Crohn. La búsqueda de la enfermedad dentro del tracto gastrointestinal se realiza con ayuda de métodos invasivos como la colonoscopia y de ayudas diagnósticas de laboratorio como cultivos, tinciones o reacción en cadena de la polimerasa (PCR). Dada la complejidad en el diagnóstico de esta forma de tuberculosis, el conocimiento y la manera en que se aborda un paciente con un cuadro sugestivo de esta enfermedad son factores importantes para establecer el manejo terapéutico oportuno. Se comparte un caso inusual de tuberculosis ileocecal como manifestación de síndrome febril prolongado con desenlace fatal.

Abstract Tuberculosis is a disease of public health importance worldwide with a high incidence in Colombia. It mainly affects the lung parenchyma. However, in a large number of cases, it is diagnosed in its extrapulmonary form, with the gastrointestinal tract being one of the most frequent sites. Mycobacterium tuberculosis has a strong predilection for the ileocecal region and the terminal ileum. Manifestations of this rare form of the disease are abdominal pain and mass sensation mainly, as well as ulcerative lesions in the intestinal mucosa and histological findings corresponding to large caseating granulomas of confluent morphology, which distinguish it from other entities such as Crohn's disease. Invasive procedures, such as colonoscopy, and diagnostic laboratory aids, such as cultures, stains, and PCR, are used to find the disease in the gastrointestinal tract. Given the difficulty of diagnosing this type of tuberculosis, knowledge and how a patient with symptoms suggestive of the disease is approached are critical factors for establishing timely treatment. The following is an unusual case of ileocecal TB as a manifestation of prolonged febrile illness with a fatal outcome.

Fístula gastroesplénica por adenocarcinoma gástrico y peritonitis difusa / Gastrosplenic fistula due to gastric adenocarcinoma and diffuse peritonitis

RESUMEN Se reporta el primer caso en Perú de una fístula gastroesplénica (FGE) secundaria a adenocarcinoma gástrico penetrante al hilio esplénico que ocasionó infarto esplénico maligno y peritonitis difusa. Se discute la racionalidad del tratamiento quirúrgico. Varón de 84 años con peritonitis difusa secundario a un adenocarcinoma gástrico Borrmann III (BIII) fístulizado al bazo y en comunicación con la cavidad peritoneal. Se hallaron en la literatura cuatro casos de FGE asociadas a cáncer gástrico. La gastrectomía con intención curativa en un solo tiempo estaría indicada para casos con buena condición general y criterios de curabilidad. La gastrectomía en un segundo tiempo se reserva para casos con mala condición general y criterios de curabilidad. Las resecciones locales o paliativas estarían indicadas para los casos con mala condición general e incurabilidad.

ABSTRACT The first case in Peru of a gastro-splenic fistula (GSF) secondary to gastric adenocarcinoma penetrating the splenic hilum, causing malignant splenic infarction and diffuse peritonitis, is reported. The rationale for surgical treatment is discussed. An 84-year-old man with diffuse peritonitis secondary to a Borrmann III (BIII) gastric adenocarcinoma fistulized to the spleen and in communication with the peritoneal cavity. Four cases of GSF associated with gastric cancer were found in the literature. The gastrectomy with curative intention in a single stage, would be indicated for cases with good general condition and criteria of curability. A second stage gastrectomy is reserved for cases with poor general condition and curability criteria. Local or palliative resections would be indicated for cases with poor general condition and incurability.

Diagnosis and treatment of acute pancreatitis complicated with splenic infarction and literature review / 中国医师杂志

Objective:To investigate the etiology, pathogenesis, clinical manifestations, and treatment of acute pancreatitis (AP) complicated with spleen infarction.Methods:A case of AP combined with splenic infarction was retrospectively analyzed and the literature was reviewed.Results:AP complicated with splenic infarction suggested that the patient′s condition was serious. The impairment of splenic immune function caused by splenic infarction may be an important cause of severe acute pancreatitis (SAP). Early detection and active treatment can obtain a good prognosis, and anticoagulant or antiplatelet aggregation treatment was not the key treatment.Conclusions:AP combined with splenic infarction may be an risk factor for SAP.

A Case of Scrub Typhus complicated with a Splenic Infarction

We present a patient with scrub typhus complicated with a splenic infarction. A 40-year-old man visited the emergency medical center complaining of fever for the previous week. He had no past medical history, but reported engaging in outdoor activities. Examination revealed a maculopapular rash on his trunk and an eschar on his epigastrium. Abdominal computed tomography was performed to examine the cause of the tenderness on the left upper quadrant of his abdomen, which revealed a splenic infarct. The patient was diagnosed with scrub typhus based on the results of blood polymerase chain reaction testing, and genetic sequencing confirmed the presence of Orientia tsutsugamushi Boryong. His symptoms improved following doxycycline treatment.

A Case of Scrub Typhus complicated with a Splenic Infarction

We present a patient with scrub typhus complicated with a splenic infarction. A 40-year-old man visited the emergency medical center complaining of fever for the previous week. He had no past medical history, but reported engaging in outdoor activities. Examination revealed a maculopapular rash on his trunk and an eschar on his epigastrium. Abdominal computed tomography was performed to examine the cause of the tenderness on the left upper quadrant of his abdomen, which revealed a splenic infarct. The patient was diagnosed with scrub typhus based on the results of blood polymerase chain reaction testing, and genetic sequencing confirmed the presence of Orientia tsutsugamushi Boryong. His symptoms improved following doxycycline treatment.

Acute Gastritis and Splenic Infarction Caused by Epstein-Barr Virus / 대한소아소화기영양학회지

Epstein-Barr virus (EBV) infection can be presented with various clinical manifestations and different levels of severity when infected. Infectious mononucleosis, which is most commonly caused by EBV infection in children and adolescents, is a clinical syndrome characterized by fatigue, malaise, fever, sore throat, and generalized lymphadenopathy. But rarely, patients with infectious mononucleosis may present with gastrointestinal symptoms and complicated by gastritis, splenic infarction, and splenic rupture. We encountered a 16-year-old girl who presented with fever, fatigue, and epigastric pain. Splenic infarction and EBV-associated gastritis were diagnosed by using esophagogastroduodenoscopy and abdominal computed tomography. Endoscopy revealed a generalized hyperemic nodular lesion in the stomach, and the biopsy findings were chronic gastritis with erosion and positive in situ hybridization for EBV. As splenic infarction and acute gastritis are rare in infectious mononucleosis and are prone to be overlooked, we must consider these complications when an infectious mononucleosis patient presents with gastrointestinal symptom.

Two Imported Cases of Babesiosis with Complication or Co-Infection with Lyme Disease in Republic of Korea

Babesiosis, caused by Babesia microti and B. divergens, is transmitted by Ixodid ticks. Symptoms of babesiosis vary from a mild flu-like illness to acute, severe, and sometimes fatal and fulminant disease. In Korea, 7 imported babesiosis cases and 1 endemic case have been reported. We report 2 cases of severe babesiosis initially mistaken as malaria. The first patient was complicated by shock and splenic infarction, the other co-infected with Lyme disease. As the population traveling abroad increases every year, physicians should be aware of babesiosis which mimics malaria, co-infection with other diseases, and its complications.

Infarto esplénico no relacionado con la altura en un paciente con rasgo falciforme: reporte de caso / Non-altitude-related splenic infarction in a patient with sickle cell trait: a case report

Resumen: presentamos el caso de un hombre mestizo de 51 años, habitante de Medellín, Colombia,con dolor agudo repentino en hipocondrio izquierdo. La tomografía contrastada de abdomen reveló la presencia de múltiples zonas de infarto esplénico. Después de una evaluación exhaustiva se descartó enfermedad cardioembólica, infecciones y trombofilia. Se solicitó una electroforesis de hemoglobina que demostró la condición de portador del rasgo falciforme. Este es uno de los pocos reportes en la literatura de un paciente con rasgo falciforme e infarto esplénico no asociado con la exposición a grandes alturas.

Abstract: we report a 51-year-old mestizo man from Medellin, Colombia, with the sudden onset of left upper abdominal pain. Computed tomography showed splenic infarction. A comprehensive patient evaluation not revealed cardioembolic disease, infections, or thrombophilia. Hemoglobin electrophoresisestablished the diagnosis of sickle cell trait. This is one of the few reports in the literature of non-altitude-related splenic infarction in a patient with sickle cell trait.

A Case of Acute Cholecystitis Caused by Plasmodium vivax Infection / 대한췌담도학회지

Acute cholecystitis as a complication of malarial disease is a rare condition, especially with Plasmodium vivax infection. A 62 year-old-female was admitted via emergency room (ER) due to high fever (40.3degrees C) and epigastric pain. Initial abdominal ultrasound and computed tomography (CT) scan showed edematous gallbladder with stone, which suggested acute calculous cholecystitis. Emergency percutaneous transhepatic gallbladder drainage (PTGBD) was done with systemic antibiotic therapy. The clinical course, however, unusually worsened with hypotension and intensive care unit (ICU) management was done. Four days after admission multi-focal splenic infarction was developed and Plasmodium vivax infection was diagnosed afterward. The clinical symptoms and laboratory results, including fever and epigastric pain, improved dramatically after anti-malarial treatment and cholecystectomy was done. The resected gallbladder (GB) specimen shows vasculitis pattern with capillary red blood cell (RBC) engorgement, which suggests the cause of cholecystitis was due to Plasmodium vivax rather than GB stone.

Splenic Infarction as the Initial Manifestation of Antiphospholipid Syndrome in a Systemic Lupus Erythematosus Patient / 대한내과학회지

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease. In patients with SLE, the prevalence of antiphospholipid antibodies is considerably higher, and is largely responsible for thrombosis. Splenic infarction is a rare complication of arterial thrombosis in patients with SLE. It is important to consider splenic infarction in a patient with SLE complaining of left upper quadrant (LUQ) pain because of the possibility of severe infarction-related complications, such as subcapsular hemorrhage and splenic rupture. We report a case of solitary splenic infarction in a patient with SLE. The only symptom was LUQ pain of 3-day duration. Lupus anticoagulant activity was positive and abdominal-pelvic computed tomography (CT) was consistent with splenic infarction. She did not show any other evidence of thrombotic events. The patient was diagnosed with antiphospholipid syndrome that presented as a splenic infarction in a SLE patient.

Idiopathic Splenic Vein Thrombosis Presenting as Splenic Infarction and Consequent Gastric Variceal Bleeding

Left-sided portal hypertension and consequent gastric varices can occur in patients with isolated splenic vein thrombosis. It is a rare but clinically significant and curable cause of gastrointestinal hemorrhage. Our patient, a 20-year-old woman, with left flank pain was diagnosed with having idiopathic splenic vein thrombosis with resultant splenic infarction. Thorough workups for the possible etiologies of splenic vein thrombosis were all negative. After six months of anticoagulation, follow-up computed tomography revealed formation of gastric varices; one month following the discovery, she developed gastrointestinal bleeding. Splenectomy was performed, resulting in the resolution of gastric varices.

Spontaneous Resolution of Emphysematous Gastritis with Vaso-occlusive Disease–A Case Report

Emphysematous gastritis secondary to vaso-occlusive disease is a surgical emergency. It is a rare yet severe form of widespread phlegmonous gastritis. It is caused by corrosive ingestion, alcohol abuse, and on rare occasions, infections. The clinical presentation is diagnostic with supportive information from contrast-enhanced computed tomography (CECT) of the abdomen and gastroduodenoscopy. Here, we describe a case of emphysematous gastritis with spontaneous vaso-occlusive disease that was successfully managed without surgery.

Infective endocarditis complicated with cerebral and splenic infarction in a hemodialysis patient / 世界急诊医学杂志（英文）

BACKGROUND:Infective endocarditis (IE) has a high risk of morbidity and mortality. Complications are often due to systemic embolization. We treated a 47-year-old hemodialysis man with infective endocarditis complicated with cerebral and splenic infarction.METHODS:The patient was brought to the emergency department because of altered mental status and fecal incontinence. Although he did not meet the Duke Criteria for IE diagnosis, clinical suspicions of IE warranted further diagnostic studies. Magnetic resonance imaging of the brain revealed cerebral infarction with abnormal neurological findings. An abdominal computerized tomography revealed an incidental and unexpected splenic infarction without physical findings. Echocardiography revealed a vegetative growth (-1.2×1 cm) over the mitral posterior leaflet with severe mitral valve regurgitation. Based on these results, the patient was diagnosed with IE complicated with severe cerebral and splenic infarction.RESULTS:The patient was treated with intravenous teicoplanin including gentamicin, subcutaneous low molecular weight heparin, and oral acetylsalicylic acid. Mitral valve replacement surgery was performed after the patient improved clinically.CONCLUSION:Emergency physicians should be aware of the life-threatening complications of IE, which may be presented subtly or without clinical evidence.

Anatomical and clinical research on splenic infarction / 中华肝胆外科杂志

Objective To study the anatomical basis and clinical causes of splenic infarction with an attempt to improve on the diagnosis and treatment of splenic infarction.Methods This study was conducted on 11 patients with splenic infarction seen in our hospital from December 2003 to September 2012,131 patients with a clinical diagnosis and treatment reported in the literature since 1999,and 25 adult cadavers showing the anatomy of the splenic arteries with an aim to find out the causes of splenic infarction.Results The clinical data showed that splenic infarction occurred more commonly in patients 60 years of age or older (73％ vs 27％,P＜0.05),and in males more than in females (62％ vs 38％,P＜0.05).The diagnosis was first made significantly more often by physicians than by surgeons 88/32 (79％ vs 21％,P＜0.05).The anatomical data showed that the majority of the splenic arteries in the 25 adult cadavers was curved.Conclusions The clinical manifestations of splenic infarction easily led to a misdiagnosis.Improvement in the diagnosis and treatment of splenic infarction would depend on the clinical awareness of this condition,the prothrombotic state detection and the implementation of timely and standardized treatment.

Infarto esplénico ¿Ergotismo inducido por ritonavir? / Splenic infarction: Ergotism induced by ritonavir?

El ergotismo es una enfermedad conocida desde la antigüedad, que se caracteriza por isquemia y, en algunos casos, gangrena de las extremidades. Muchas drogas de uso corriente tienen la capacidad de interactuar con los ergotamínicos desarrollando ergotismo como efecto adverso. Un ejemplo de ello es el ritonavir, un inhibidor de la proteasa utilizado en pacientes con el virus de la inmunodeficiencia humana (HIV). Presentamos un caso de ergotismo en un varón de 39 años con infección por HIV en tratamiento con ritonavir que, después de ingerir 1 mg de tartrato de ergotamina, además de presentar manifestaciones clásicas de la enfermedad, desarrolló un infarto esplénico. Por lo tanto, consideramos importante advertir a los pacientes sobre la posible interacción farmacológica entre los ergotamínicos y otras drogas de uso frecuente y, en particular, el ritonavir en pacientes portadores de HIV.

Ergotism is a clinical condition known since old times and whose main characteristics are ischemia and even limb gangrene. Some drugs have the capacity of interacting with small amounts of ergotamine or its derivatives producing ergotism as a side effect. This is the case of ritonavir, a widely used anti-HIV drug. Here we present a case of ergotism that developed in an HIV positive 39 year old male under treatment with ritonavir, after taking 1 mg of ergotamine tartrate. His clinical picture, apart from showing the basic manifestations of the disease, was associated with splenic infarction. For this reason, we consider important to advise patients about the potential pharmacological interaction between ergotamines and others common drugs and, in particular, ritonavir in HIV positive patients.