Torsión e infarto esplénico en paciente pediátrico. Presentación de caso / Torsion and Splenic Infarction in Pediatric Patient. A Case Report

El bazo errante es una patología poco común, en la cual el bazo se encuentra fuera de su ubicación habitual, como consecuencia de una laxitud anormal o ausencia de ligamentos, lo cual predispone a torsión e infarto; es más frecuente en niños menores de 10 años y en mujeres en la tercera década de la vida. A menudo, los pacientes consultan por una masa abdominal asintomática, o síntomas gastrointestinales subagudos e incluso abdomen agudo. El diagnóstico se realiza mediante imágenes y su manejo es quirúrgico. El caso examinado corresponde a una paciente de sexo femenino de 11 años de edad, diagnosticada con torsión e infarto esplénico mediante ecografía y tomografía axial computarizada (TAC); se realiza manejo quirúrgico sin complicaciones

Wandering spleen is a rare pathology in which the spleen is not in its usual location, secondary to abnormal laxity or absence of ligaments, predisposing to torsion and infarction, more frequent in children under 10 years of age and women in the third decade of life. Patients often consult for an asymptomatic abdominal mass or subacute gastrointestinal symptoms and even acute abdomen. Diagnosis is made through images and its management is surgical. In this case, an 11-year-old female patient is presented, diagnosed with splenic torsion and infarction by computerized axial tomography (CT) and ultrasound. Surgical management is performed without complications

Infarto esplénico asociado a infección por citomegalovirus, primer reporte de caso en Colombia / Splenic infarction associated with cytomegalovirus infection, first Colombian Case report

Resumen Introducción: El infarto esplénico ocurre cuando la arteria esplénica o alguna de sus ramas quedan ocluidas, ya sea por émbolos distantes o por trombosis in situ. Dentro de la literatura mundial hay muy pocos casos documentados de infarto esplénico asociado a infección por Citomegalovirus, por lo que este podría considerarse el primero en Colombia. Presentación del Caso: Se trata de una paciente femenina de 53 años quien fue atendida en una institución de tercer nivel de la Ciudad de Bogotá, Colombia, por cuadro de dolor abdominal, a quien se le realizó una tomografía abdominal contrastada que demostró en el bazo una lesión hipodensa en cuña correspondiente con infarto esplénico por lo cual se realizaron estudios complementarios evidenciando como único dato positivo la positividad de la IgM para Citomegalovirus, descartándose eventos de h ipercoagulabilidad. Discusión: El infarto esplénico es una condición infrecuente que normalmente se presenta con síntomas variables e inespecíficos, dentro de las enfermedades infecciosas que corresponden con aproximadamente el 30% de los diagnósticos de Infarto esplénico, la infección por Citomegalovirus únicamente ha sido reportada en muy pocos casos. Se presenta el caso de una mujer joven con infarto esplénico como diagnóstico final de dolor abdominal en quien se descartaron causas de hipercoagulabilidad y se confirma la infección aguda por Citomegalovirus, lo cual se ha descrito muy poco en la literatura y puede considerarse el primer caso reportado en Colombia.

Abstract Introduction: Splenic infarction occurs when the splenic artery or any of its branches are occluded, either by distant emboli or by thrombosis in situ. Within the world literature, there are very few documented cases of splenic infarction associated with Cytomegalovirus infection, so this could be considered the first in Colombia. Case Presentation: This is a 53-year-old female patient who was treated at a third-level institution in the City of Bogotá, Colombia, for symptoms of abdominal pain, who underwent a contrasted abdominal tomography that she demonstrated in the spleen. a hypodense wedge lesion corresponding to splenic infarction, for which reason complementary studies were carried out, showing the positivity of IgM for Cytomegalovirus as the only positive data, ruling out events of hypercoagulability. Discussion: Splenic infarction is an infrequent condition that normally presents with variable and nonspecific symptoms. Among infectious diseases that correspond to approximately 30% of the diagnoses of splenic infarction, Cytomegalovirus infection has only been reported in very few cases. The case of a young woman with splenic infarction is presented as the final diagnosis of abdominal pain in whom causes of hypercoagulability were ruled out and acute infection by Cytomegalovirus was confirmed, which has been described very little in the literature and can be considered the first reported case In colombia.

Infarto esplénico como complicación de gastrectomía vertical laparoscópica. Reporte de caso / Splenic infarction as a complication of laparoscopic vertical gastrectomy. Case report

La gastrectomía vertical laparoscópica es actualmente la cirugía bariátrica más empleada a nivel mundial. Aunque es un procedimiento seguro y efectivo pueden ocurrir complicaciones mayores. En el presente trabajo reportamos el caso de un infarto y absceso esplénico como una rara complicación de esta técnica, que requirió finalmente de esplenectomía como tratamiento definitivo. Caso clínico: Mujer de 22 años con obesidad grado I, a quien se le practicó gastrectomía vertical laparoscópica con buena evolución intrahospitalaria y egreso a las 48 horas. Al 4to día posoperatorio consultó por fiebre, dolor abdominal, taquipnea y taquicardia. Mediante tomografía computada de abdomen se diagnosticó infarto esplénico parcial. Recibió tratamiento médico con remisión inicial de los síntomas, los cuales reaparecieron a la 3era semana. Se reinició el tratamiento médico, esta vez sin respuesta, y con evolución al absceso esplénico. Se decidió esplenectomía como tratamiento definitivo logrando la recuperación completa de la paciente. Conclusión: El infarto esplénico es una complicación infrecuente de la gastrectomía vertical. Su tratamiento inicial es médico, reservando la esplenectomía para los casos que no responden(AU)

Laparoscopic sleeve gastrectomy is currently the most performed bariatric surgery worldwide. Although it is an effective and safe procedure major complications can occur. In the present manuscript we report a case of splenic infarct and abscess as a rare complication of laparoscopic sleeve gastrectomy, finally requiring a splenectomy as a definitive treatment. Case report: A 22 years old woman with grade I obesity underwent laparoscopic sleeve gastrectomy with good hospital evolution and 48 hours discharge. On the 4th postoperative day she return because fever, abdominal pain, tachypnea and tachycardia. By means of a computed tomography a splenic infarct was diagnosed. She received medical treatment with initial remission of symptoms, which reappear at the third week. Medical treatment was restarted, this time without success, and with progression to splenic abscess. We decided a splenectomy as definitive treatment achieving a complete patient recovery. Conclusion: Splenic infarction is a rare complication after sleeve gastrectomy. The treatment is non surgical, reserving the splenectomy for the non responded cases(AU)

Infarto esplénico masivo en un paciente pediátrico sin factores predisponentes / Massive splenic infarct in a pediatric patient without predisposing factors

El infarto esplénico es una entidad rara en la edad pediátrica que, cuando se encuentra, se asocia a otros factores predisponentes, como enfermedades oncológicas, hematológicas o infecciosas. Su presentación es asintomática o sintomática con dolor abdominal, fiebre y esplenomegalia. No existe consenso sobre cuál es la mejor opción de tratamiento, y se decide, en la mayoría de los casos, un manejo conservador o quirúrgico de acuerdo con las características individuales del paciente. Se presenta el caso de un paciente escolar que acude por un cuadro de dolor abdominal agudo y fiebre con diagnóstico de infarto esplénico masivo sin etiología aparente que fue manejado de manera conservadora, con evolución favorable. Es importante considerar este padecimiento como causa de dolor abdominal asociado a esplenomegalia y destacar la relevancia de esta presentación de caso, ya que se presenta sin relación con enfermedades subyacentes.

Splenic infarction is a rare entity in the paediatric age that, when found, is associated with other predisposing factors such as oncological, haematological or infectious diseases. It is whether asymptomatic or symptomatic with abdominal pain, fever and splenomegaly. There is no consensus on which is the best treatment option, in most cases deciding conservative or surgical management according to individual patient characteristics. We present the case of a patient with acute abdominal pain and fever with a diagnosis of massive splenic infarction without apparent aetiology that was managed conservatively with favourable evolution. It is important to consider this condition as a cause of abdominal pain associated with splenomegaly.

Bazo errante gigante con torsión del pedículo e infarto esplénico: reporte de un caso / Giant Wandering Spleen with torsion of the pedicle and splenic infarction: a case report

INTRODUCCIÓN: El bazo errante, es una entidad clínica poco común. Su espectro clínico varía desde enfermedad asintomática hasta complicaciones asociadas y su manejo es predominantemente quirúrgico. CASO CLÍNICO: Hombre, con cuadro clínico de dolor y masa abdominal palpable, con hallazgos tomográficos sugestivos de patología con asiento en retroperitoneo, con obstrucción intestinal secundaria; por laparotomía se identifica de forma incidental bazo ectópico solo fijado a través de pedículo vascular torsionado y signos de hipertensión portal, realizándose esplenectomía. CONCLUSIONES: La torsión esplénica es la complicación más frecuente del bazo errante, una entidad bastante rara con muy pocos casos publicados en Colombia.

BACKGROUND: The wandering spleen is an uncommon clinical entity. Its clinical spectrum varies from asymptomatic disease to associated complications and its management is predominantly by surgery. CLINICAL CASE: Man with clinical picture of pain and palpable abdominal mass, with tomographic findings suggestive of pathology with retroperitoneal seating, with secondary intestinal obstruction; by laparotomy incidentally, an ectopic spleen is identified, only fixed through a torsioned vascular pedicle and signs of portal hypertension, performing splenectomy. CONCLUSIONS: Splenic torsion is the most frequent complication of the errant spleen, a very rare entity with very few cases published in Colombia.

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.

traveler to Holland with a benign killer: a case report of a sickle cell trait male with splenic infarction

Sickle cell trait is highly prevalent in Saudi Arabia. However, most of the patient are asymptomatic, only few present with symptoms of the complications of the disease. We report a case of 24-year-old male who presented to the hospital with history of dull left upper quadrant, nausea and vomiting while he was on the airplane. Investigation showed a picture of sickle cell trait with hemoglobin S of 40%. Peripheral blood smear was within normal. CT scan of the abdomen confirmed the presence of splenic infraction. This case emphasized on the need to increase the level of threshold to recognize the rare complications of sickle cell trait and how to manage them appropriately

Ischemic Necrosis of the Gastric Remnant without Splenic Infarction Following Subtotal Gastrectomy

Gastric remnant necrosis after a subtotal gastrectomy is an extremely uncommon complication due to the rich vascular supply of the stomach. Despite its rareness, it must be carefully addressed considering the significant mortality rate associated with this condition. Patients vulnerable to ischemic vascular disease in particular need closer attention and should be treated more cautiously. When gastric remnant necrosis is suspected, an urgent endoscopic examination must be performed. We report a case of gastric remnant necrosis following a subtotal gastrectomy and discuss possible risk factors associated with this complication.

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.

Splenic infarction associated with acute infectious mononucleosis

No abstract available.

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.

Unexpected Multiple Organ Infarctions in a Poisoned Patient / 대한구급학회지

Predisposing factors for venous thrombosis can be identified in the majority of patients with established venous thromboembolism (VTE). However, an obvious precipitant may not be identified during the initial evaluation of such patients. In the present case, a 47-year-old female presented to the emergency department of our hospital after ingesting multiple drugs. She had no VTE-related risk factors or previous episodes, nor any family history of VTE. After admission to the intensive care unit sudden hypoxemia developed, and during the evaluation cerebral, renal, and splenic infarctions with pulmonary embolisms were diagnosed. However, the sources of the emboli could not be identified by transthoracic echocardiography or computed tomography angiography. Protein C deficiency was identified several days later. We recommend that hypercoagulable states be taken into consideration, especially when unexplained thromboembolic events develop in multiple or unusual venous sites.

Unexpected Multiple Organ Infarctions in a Poisoned Patient / 대한중환자의학회지

Predisposing factors for venous thrombosis can be identified in the majority of patients with established venous thromboembolism (VTE). However, an obvious precipitant may not be identified during the initial evaluation of such patients. In the present case, a 47-year-old female presented to the emergency department of our hospital after ingesting multiple drugs. She had no VTE-related risk factors or previous episodes, nor any family history of VTE. After admission to the intensive care unit sudden hypoxemia developed, and during the evaluation cerebral, renal, and splenic infarctions with pulmonary embolisms were diagnosed. However, the sources of the emboli could not be identified by transthoracic echocardiography or computed tomography angiography. Protein C deficiency was identified several days later. We recommend that hypercoagulable states be taken into consideration, especially when unexplained thromboembolic events develop in multiple or unusual venous sites.

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.

Multiple splenic infarcts in acute Plasmodium vivax malaria: a rare case report

In tropical countries like India, malaria has been one of the most common parasitic illnesses leading to frequent hospitalization and causing major economic burden among the masses. Although Plasmodium vivax infection is considered to be benign, in contrast to Plasmodium falciparum infection which is notorious for its severe splenic complications can occur frequently. Splenomegaly tends not to receive special attention, as it is not usually accompanied by any symptoms and can be gradually resolved via standard antimalarial therapy. Splenic infarction, although rarely attributable to malaria in an endemic region with high parasitemia, can be a rare presentation of this disease entity.