Ruptura atraumática del bazo como forma de presentación de la una amilosis AL en un paciente joven / Spontaneous non-traumatic splenic rupture as a presentation form of light chain amyloidosis. Report of one case

We report a 35-year-old sportive man who was admitted to the emergency department for worsening of acute spontaneous abdominal pain appearing at rest. He only referred having lifted a tree trunk the day before, but he was used to perform such physical efforts. The clinical course at the emergency department was marked by the development of severe anemia secondary to a progressive splenic hematoma and acute pulmonary distress. The patient benefited from total splenectomy. Laboratory data showed hypogammaglobulinemia, proteinuria and the anatomopathological examinations of both spleen and kidneys were consistent with light chain amyloidosis.

A STUDY OF PATIENTS PRESENTING WITH BLUNT ABDOMINAL INJURY WITH SPLENIC TRAUMA AND THEIR OUTCOME.

INTRODUCTION - Spleen injuries are among the most frequent trauma-related injuries. At present, they are classified according to the anatomy of the injury. The optimal treatment strategy, however, should keep into consideration the hemodynamic status, the anatomic derangement, and the associated injuries. The management of splenic trauma patients aims to restore the homeostasis and the normal physiopathology with a multidisciplinary team. Thus, the study to determine the presentation of a patient and further its investigation management and outcome is necessary. OBJECTIVE: To study all the cases (investigation and outcome) of blunt abdominal trauma with splenic laceration with its incidence , mode of presentation, grade, management and factors responsible for morbidity and mortality. MATERIALAND METHODS:Astudy was conducted in our tertiary care hospital on 22 patients presented with blunt abdominal trauma with splenic injury in emergency department during July 2019 to June 2021. RESULTS: In our retrospective study , all the patients underwent primary radiological and pathological investigation with 36% having associated limb injuries (fractures);4.5% with ckd , 9% with thoracic injury, 40% amongst 20-40 age group , 86% being male, 59.5% resulted from RTA, 31.5 % resulted from fall from height,0% with assault, 4.5% along with head injury, 9% with associated rib fracture,0% patient with free gas under diaphragm ; 9% with grade 1, 22% with grade 2, 31.5% grade 3 , 13.5% grade 4, 22%grade 5 splenic injuries. 91% patients underwent splenectomy and were given vaccination 15 days post operatively against capsulated organisms.9% patients were managed conservatively. Patients were followed up for 6 months postoperatively with 4.5% mortality rate. CONCLUSION: Splenic injury is most common solid organ injury in blunt abdominal trauma in 20- 40 years age group majority male and results maximally by RTA; associated with limb fractures commonly with liver as associated solid organ injured. Aggressive resuscitation and emergency laparotomy (splenectomy) yields excellent outcome

Analysis of risk factors for thrombocytosis after splenectomy in patients with traumatic splenic rupture and construction of nomogram model / 中国医师进修杂志

Objective:To construct a nomogram model that can be used to predict thrombocytosis after splenectomy in patients with traumatic splenic rupture.Methods:The clinical data of 54 patients with splenectomy in Lu′an People′s Hospital from November 2016 to November 2021 were retrospectively analyzed. Among them, postoperative thrombocytosis occurred in 33 cases (postoperative thrombocytosis group), and 21 cases had no significant changes in platelets (postoperative platelet normal group). The general clinical data were recorded; the platelet parameters 14 d after operation were measured, including platelet count, mean platelet volume (MPV), procalcitonin (PCT) and platelet distribution width (PDW). The receiver operating characteristic (ROC) curve was drawn to analyze the predictive value of platelet parameters for thrombocytosis after splenectomy in patients with traumatic splenic rupture. Multivariate Logistic regression analysis was used to analyze independent risk factors of thrombocytosis after splenectomy in patients with traumatic splenic rupture. A nomogram model to predict thrombocytosis after splenectomy in patients with traumatic splenic rupture was established with R language software 4.0.2 package, internal validation of the nomogram model was performed using correction curves, and the prediction efficiency of the nomogram model was evaluated using decision curves.Results:The incidence of shock, rate of blood transfusion volume≥2 000 ml, platelet count and PCT in postoperative thrombocytosis group were significantly higher than those in postoperative platelet normal group: 69.70% (23/33) vs. 19.05% (4/21), 66.67% (22/33) vs. 38.10% (8/21), (823.56 ± 129.81) ×10 9/L vs. (521.92 ± 85.89) ×10 9/L, (0.87 ± 0.11)% vs. (0.54 ± 0.09)%, the MPV and PDW were significantly lower than those in postoperative platelet normal group: (10.23 ± 1.03) fl vs. (11.57 ± 0.92) fl and 0.113 ± 0.012 vs. 0.125 ± 0.020, and there were statistical differences ( P<0.01 or <0.05). ROC curve analysis results show that the area under curve of platelet count, MPV, PCT and PDW in for predicting the thrombocytosis after splenectomy in patients with traumatic splenic rupture were 0.973, 0.835, 0.987 and 0.734, and the optimal cut-off values were 642.29 ×10 9/L, 11.02 fl, 0.7% and 0.120. Multivariate Logistic regression analysis result showed that the platelet count, MPV, PCT, PDW, shock and blood transfusion volume were independent risk factors for thrombocytosis after splenectomy in patients with traumatic splenic rupture ( OR = 1.571, 1.243, 1.042, 1.413, 1.436 and 1.726; 95% CI 0.014 to 1.762, 0.743 to 2.862, 0.954 to 2.563, 0.584 to 2.389, 0.045 to 2.643 and 0.154 to 2.143; P<0.01 or <0.05). When platelet count, MPV, PCT, PDW, shock and blood transfusion volume were included as predictors for constructing the nomogram model, the internal validation results showed that the C-index of the nomogram model for predicting thrombocytosis after splenectomy in patients with traumatic splenic rupture was 0.793 (95% CI 0.267 to 2.311); the threshold value of the nomogram model for predicting thrombocytosis after splenectomy in patients with traumatic splenic rupture was >0.067, and the nomogram model provided a net clinical benefit; the clinical net benefit of the nomogram model was greater than that of platelet count, MPV, PCT, PDW, shock and blood transfusion volume. Conclusions:The nomogram model based on platelet count, MPV, PCT, PDW, shock and blood transfusion volume that affect the high risk of thrombocytosis after splenectomy in patients with traumatic splenic rupture has great clinical value in screening and identifying high risk patients.

Rotura esplénica espontánea secundaria a mononucleosis infecciosa / Spontaneous splenic rupture secondary to infectious mononucleosis

Resumen La rotura esplénica es una complicación rara pero potencialmente fatal de la mononucleosis infecciosa. Presentamos el caso de una mujer de 18 años que consultó por dolor abdominal de siete días de evolución, asociado a fiebre y pérdida de conciencia brusca y transitoria. En el hemograma presentaba una anemia y linfocitosis. Se realizó una tomografía computada de abdomen y pelvis que mostró un extenso hemoperitoneo, con el bazo rodeado por un hematoma, y numerosas adenopatías cervicales, mesentéricas e inguinales. Se efectuó una laparoscopía que demostró abundante hemoperitoneo con coágulos a lo largo de la gotera parietocólica izquierda. El bazo estaba completamente decapsulado y rodeado por una colección hemática con sangrado en napa. Se realizó una esplenectomía total sin complicaciones. El estudio histopatológico esplénico mostró una atenuación de la pulpa blanca y expansión de la pulpa roja con áreas de hemorragia y necrosis. La IgM anti-cápside para virus de Epstein Barr fue positiva. La paciente evolucionó de manera favorable.

Abstract Splenic rupture is a rare but potentially fatal complication of infectious mononucleosis. We report the case of an 18-year-old woman, who presented a 7-day history of abdominal pain, sudden temporary loss of consciousness and fever. Admission blood tests showed anemia, and lymphocytosis. Computed tomography of the abdomen and pelvis demonstrated extensive hemoperitoneum and numerous cervical, mesenteric and inguinal enlarged lymph nodes. Laparoscopy was performed and abundant hemoperitoneum with blood clots along the left parietocolic gutter were observed. The spleen was completely decapsulated and surrounded by a hematoma and the subcapsular tissue was bleeding. Total splenectomy was performed without complications. Splenic histology demonstrated white pulp attenuation and expansion of the red pulp with focal hemorrhage and necrosis. IgM anti-viral capsid antigen of Epstein Barr virus was positive. The patient had a satisfactory recovery.

Mantle cell lymphoma presenting with lethal atraumatic splenic rupture

Mantle cell lymphoma is characterized by t(11;14) with CCND1-IGH fusion and manifests with a spectrum of disease ranging from relatively indolent to aggressive. Here, we present a case of pleomorphic mantle cell lymphoma with three fusion signals that presented with lethal atraumatic splenic rupture. We discuss on the implications of variant CCND1 signal patterns as well as the epidemiology and pathophysiology of atraumatic splenic rupture.

Linfoma de Burkitt en paciente adulto inmunocompetente que se presenta como rotura esplénica espontánea / Burkitt's lymphoma in an immunocompetent adult patient presenting as spontaneous splenic rupture

RESUMEN El linfoma de Burkitt es un linfoma no Hodgkin de células B que ha sido denominado por la mayoría de los investigadores como el tumor humano de crecimiento más rápido, pues es capaz de lograr una tasa de duplicación celular entre 24 y 26 horas. Se presentó un paciente masculino de 48 años de edad, con diagnóstico de linfoma de Burkitt, inmunocompetente, con esplenomegalia gigante y rotura esplénica espontánea como complicación. El paciente tuvo una evolución desfavorable en un breve período de tiempo. El linfoma de Burkitt es una enfermedad altamente agresiva, donde la falta de sospecha clínica y diagnóstico no oportuno ensombrecen el pronóstico.

ABSTRACT Burkitt's lymphoma is a B-cell non-Hodgkin lymphoma that has been called by most researchers the fastest growing human tumor, as it is capable of achieving a cell doubling rate between 24 and 26 hours. We present a 48-year-old male patient with a diagnosis of Burkitt's lymphoma, immunocompetent, with giant splenomegaly and spontaneous splenic rupture as a complication. The patient had an unfavorable evolution in a short period of time. Burkitt's lymphoma is a highly aggressive disease, where lack of clinical suspicion and untimely diagnosis overshadow the prognosis.

Splenic vessel bleeding in puerperium: a rare maternal near miss case

Splenic rupture is a very rare entity during pregnancy and puerperium. It has a very high maternal mortality if not diagnosed and managed in time. Here we are presenting a very rare case of splenic haemorrhage on day 5 lower segment caeserian section which was diagnosed and managed at RIMS, Ranchi, Jharkhand, India.

Caracterización de pacientes con trauma esplénico atendidos en un hospital de tercer nivel entre enero de 2000 y diciembre de 2017 / Characteristics of splenic trauma patients treated at a level III hospital between January 2000 and December 2017

Introducción. Es frecuente (46 %) que la lesión esplénica se acompañe de otra lesión visceral concomitante, con una alta tasa de morbimortalidad. La evolución de las técnicas para el abordaje de estas lesiones incluye procedimientos quirúrgicos, intervencionistas y de manejo expectante. Métodos. Se trata de un estudio con cohorte única retrospectiva y observacional. Se incluyeron pacientes mayores de 13 años de edad con trauma esplénico, atendidos entre enero de 2000 y diciembre de 2017. Se describieron las características relacionadas con el proceso de atención.Resultados. Se identificaron 116 pacientes con trauma esplénico, el 85,2 % de ellos hombres, con una edad promedio de 26 años. El 75,9 % de los pacientes presentaba lesiones concomitantes; las más frecuentes fueron de diafragma (31,0 %), de hígado (17,2 %) y de riñón (11,2 %). Los mecanismos de lesión más frecuentes fueron por arma corto-punzante (29,3 %), por arma de fuego (22,4 %) y por accidentes de tránsito (22,4 %). La gravedad fue clasificada como de grado V en el 24,1 % de los pacientes y de grado I en el 23,3 %. Se practicó esplenectomía total en el 39,7 % de los pacientes y el 15,2 % fue manejado de forma conservadora. La mortalidad fue del 4,3 %, tres casos en el posoperatorio inmediato (menos de 24 horas) y dos en la primera semana postoperatoria. Discusión. El manejo conservador de las lesiones esplénicas de poca gravedad es una estrategia segura y efectiva, con una tasa de fracaso de menos del 5 %. El abordaje quirúrgico se reserva para lesiones de mayor gravedad y su relación con otros órganos lesionados, con una mayor morbimortalidad (63 %)

Introduction. Splenic injuries are usually accompanied by another concomitant visceral lesion (46 %), with a high rate of morbidity and mortality. The evolution of techniques for approaching these injuries includes surgical, interventional and expectant management procedures.Methods. Retrospective, observational single cohort study. Patients older than 13 years of age with splenic trauma who were treated between January 2010 and December 2017 were included. The characteristics related to the care process were described.Results. 116 patients with splenic trauma were identified, 85,2 % were men and the average age was 26 years. Concomitant lesions were identified in 75,9% of patients, the most common were diaphragm (31 %), liver (17,2 %), and kidney (11,2 %). The most common mechanisms of injury were stab wounds (29,3 %), gunshot wounds (22,4 %), and motor vehicle collisions (22,4 %). Severity was classified as grade V in 24,1 % of patients and grade I in 23,3 %. Total splenectomy was performed in 39,7 % of patients and 15,2 % was conservatively managed. Mortality was 4,3 %, three cases in the immediate postoperative period (within 24 hours) and two in the first week postoperative week. Discussion. Conservative management of low-grade splenic injuries is a safe and effective strategy, with a failure rate of less than 5 %. Surgical approach is reserved for injuries with greater severity and their relationship with other injured organs, with greater morbidity and mortality (63 %)

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)

Spontaneous Splenic Rupture in a Peritoneal Dialysis Patient / 대한내과학회지

Atraumatic splenic rupture (ASR) in a patient undergoing peritoneal dialysis (PD) is uncommon, but can be life-threatening. According to recent systematic reviews, the major causes of ASR are 1) neoplastic (30.3%), 2) infectious (27.3%), 3) non-infectious inflammatory (20.0%), 4) iatrogenic (9.2%), 5) mechanical (6.8%), and 6) idiopathic (6.4%). It is diagnosed by imaging studies, most commonly ultrasonography and computed tomography (CT). Due to its rarity, the early diagnosis of ASR is difficult, and no standard treatment has been described. Here, we report a case of idiopathic ASR in a patient undergoing PD. The diagnosis was established by abdominal CT scan, and splenectomy was performed. Thus, hemoperitoneum in a PD patient should raise suspicion of ASR. Early diagnosis and appropriate treatment will lead to a better outcome.

Subcapsular Splenic Hemorrhage in Vivax Malaria

In malaria, splenic rupture is a serious complication potentially leading to death. Subcapsular hemorrhage of spleen is thought to be an impending sign of splenic rupture; however, the characteristics of subcapsular hemorrhage are not well known. We report 3 cases of subcapsular hemorrhage of the spleen in vivax malaria, with varying degrees of severity. Case 1 showed subcapsular hemorrhage without splenic rupture, was treated by antimalarial drug without any procedure. The healing process of the patient's spleen was monitored through 6 computed tomography follow-up examinations, over 118 days. Case 2 presented subcapsular hemorrhage with splenic rupture, treated only with an antimalarial drug. Case 3 showed subcapsular hemorrhage with splenic rupture and hypotension, treated using splenic artery embolization. They all recovered from subcapsular hemorrhage without any other complications. These 3 cases reveal the process of subcapsular hemorrhage leading to rupture and a potentially fatal outcome. The treatment plan of subcapsular hemorrhage should be determined carefully considering the vital signs, changes in hemoglobin, and bleeding tendency.

Clinical experience of laparoscopic splenectomy in 62 cases of traumatic spleen rupture / 中华普通外科杂志

Objective To analyze the safety of laparoscopic splenectomy for traumatic splenic rupture.Methods The clinical data of 62 patients with traumatic splenic rupture treated by laparoscopic splenectomy in our hospital from Jan 2013 to Jan 2018 were retrospectively analyzed.Results All 62 patients successfully underwent laparoscopic surgery except for 1 case who was converted to open surgery.One case suffered from postoperative bleeding.There was no infection,serious pancreatic leakage and other major complications.The total amount of intraoperative bleeding was 1 600 ml on average,the average operation time was 135 min,the average splenectomy time was 55 min,and the average hospital stay was 12.5 d.Conclusion Laparoscopic splenectomy is a safe and reliable minimally invasive operation for traumatic splenic rupture.

Nontraumatic Splenic Rupture due to Infectious Mononucleosis

A 19-year-old otherwise healthy male presented to the Emergency Department with left upper quadrant abdominal pain having felt a “pop” in his abdomen which was followed by nausea and lightheadedness. There was no evidence of trauma but 3 weeks earlier he began with symptoms of a sore throat and nasal congestion without cough. On subsequent investigation, given the patient's acute abdominal pain, abnormal vitals and a non-diagnostic computed tomography scan, an emergent exploratory laparotomy was performed. There was 600 mL of blood evacuated from the abdomen. A 643-gram inflamed and ruptured spleen was identified and removed, and follow-up lab work was positive for heterophile antibody. This report describes spontaneous splenic rupture caused by infectious mononucleosis and compares characteristics of traumatic versus non-traumatic cases.

Espectro de hallazgos por TC multidetector en el trauma esplénico y hepático / Multidetector CT Findings in Splenic and Liver Trauma

El trauma abdominal cerrado puede ser causa de lesiones en varios órganos sólidos, siendo el bazo y el hígado más frecuentemente afectados en ese tipo de situaciones. La tomografía computada multicorte (TCMC), es el método de imágenes de elección en la evaluación de pacientes que sufrieron un trauma cerrado abdominal gracias a que aporta un rápido y preciso diagnóstico y permite un eficaz tratamiento. El objetivo de este trabajo, es describir el espectro de las lesiones esplénicas y hepáticas encontradas en el trauma abdominal cerrado.

Blunt Abdominal Trauma can cause lesions in several abdominal solid organs. The spleen and liver are most frequently injured in such situations. Multi Slice Computed Tomography (MSCT) is the method of choice in the evaluation of patients who suffered a closed abdominal trauma to provide a quick and accurate diagnosis and allow faster and more effective treatment. This pictorial essay aims to describe the most frequent spleen and liver injuries in blunt abdominal trauma.

Rotura espontánea de bazo en paciente tratado con acenocumarol / Spontaneous rupture of spleen in a patient treated with acenocoumarol

Aunque la causa más frecuente de rotura esplénica es la traumática, podemos encontrar roturas sin relación a un traumatismo previo. Se está objetivando un aumento de roturas espontáneas en relación con tratamiento anticoagulante. Presentamos el caso de un hombre en tratamiento con acenocumarol que presentó una rotura espontánea esplénica que requirió esplenectomía urgente. La rotura de bazo es una entidad grave que debe considerarse ante todo paciente con un abdomen agudo. Aunque las causas más frecuentes de rotura esplénica atraumática son las complicaciones neoplásicas e infecciosas, se han objetivado varios casos asociados a terapias antiagregantes y anticoagulantes. Dado el aumento de población que precisa anticoagulación oral, la sobredosificación con acenocumarol debe considerarse como una posible causa de rotura esplénica. Debemos sospechar esta entidad ante todo paciente en tratamiento con anticoagulación oral con un abdomen agudo.

The splenic rupture is most commonly related to trauma, but spontaneus ruptures have also been described with increasing frequency. We present a case of a male patient with spontaneous splenic rupture due to oral anticoagulant overdose that required urgent splenectomy. The spontaneous splenic rupture is a life-threatening condition that must be considered in patients with acute abdomen. Although most ruptures are associated with to neoplastic and infectious complications , recent reports have related rupture with anticoagulant and antiaggregant therapies. Moreover, since the number of patients undergoing oral anticoagulant therapies is growing, overdose of anticoagulant drugs must be considered as a possible ethiology of spontaneous splenic rupture and suspect this association in patient with acute abdomen undergoing anticoagulant therapy.

Application of rotary cutter during laparoscopic splenectomy / 中国内镜杂志

Objective To explore the feasibility and clinical effects of rotary cutter in laparoscopic splenectomy in treatment of traumatic spleen rupture.Methods The study retrospectively identified 10 cases with traumatic spleen rupture treated with laparoscopic splenectomy from June 2014 to June 2016.Results Total laparoscopic splenectomy combined with rotary cutter was completed successfully in 9 cases and 1 case was converted to open laparotomy due to intraoperative uncontrollable hemorrhage. The former operative time was 95 ~ 170 min, the estimated intraoperative amount of blood loss was 300 ~ 800 ml and autologous blood transfusion of 400 ~ 1 200 ml was conducted. The postoperative hospital stay was 8 ~ 14 d. No serious complications were found in the cases followed-up for 3 ~ 24 months after operation.Conclusion Laparoscopic splenectomy combined with rotary cutter is not only feasible and safe but also has the merits of minimally invasive surgery. It can be applied in treating those with abdominal trauma and with benign lesions in spleen. So it deserved promotion and application in clinical work.

Ruptura esplênica secundária à infeção por Plasmodium falciparum / Splenic rupture secondary to Plasmodium falciparum infection

A ruptura esplênica é uma complicação possível da malária. É importante pela dificuldade diagnóstica, pois um elevado índice de suspeição é necessário para um diagnóstico atempado. Pode condicionar uma hemorragia intraperitoneal e deve ser considerada no diagnóstico diferencial de quadros de dor abdominal, hipotensão e diminuição do hematócrito. Os autores descrevem o caso de um homem de 59 anos, com ruptura esplênica secundária à malária por Plasmodium falciparum, tendo realizado esplenectomia urgente. Com a apresentação do caso, os autores pretendem chamar a atenção para a necessidade de incluir esta afecção no diagnóstico diferencial dos doentes com malária e hipotensão refractária.

Splenic rupture is a possible complication of malaria. Due to its difficult diagnosis, it is important, because a high level of suspicion is needed for a timely diagnosis. It results in intraperitoneal bleeding and should be considered in the differential diagnosis of abdominal pain, hypotension and low hematocrit. The authors report the case of a 59-year old man with splenic rupture secondary to malarial infection by Plasmodium Falciparum, who was treated with urgent splenectomy. This case is presented to remind the clinicians of include this entity in the differential diagnosis of patients with malaria and refractory hypotension.

Ruptura esplénica en el puerperio asociada con preeclampsia / Splenic rupture in the puerperium associated with preeclampsia

Resumen ANTECEDENTES: la ruptura esplénica es una complicación muy rara del embarazo y del puerperio, con una mortalidad materna y fetal extremadamente alta. La mortalidad materna alcanza alrededor de 75% y la fetal incluso 95%, complicándose más frecuentemente durante el tercer trimestre (69%) y pocas veces en el puerperio. CASO CLÍNICO: paciente de 37 años de edad, con embarazo de 31.1 semanas enviada a nuestro hospital por preeclampsia, con datos de severidad, con alteraciones bioquímicas y difícil control de la tensión arterial. En el posoperatorio inmediato tuvo un cuadro de dolor abdominal agudo, con líquido libre en el ultrasonido abdominal por lo que se le efectuó una laparotomía de urgencia, con hallazgo de una lesión de 3 cm, aproximadamente, en el polo inferior e hilio esplénico; se realizó esplenectomía de urgencia. El periodo posoperatorio cursó sin incidentes y la paciente fue dada de alta a los 8 días después de la cirugía. CONCLUSIONES: el diagnóstico y tratamiento oportuno de la ruptura esplénica en el puerperio asociada con preeclampsia previene la muerte materna por esta causa.

Abstract BACKGROUND: Splenic rupture is a very rare complication of pregnancy and puerperium, with extremely high maternal and fetal mortality. Maternal mortality reaches about 75% and fetal mortality up to 95%, complicating more frequently during the third trimester (69%) and rarely in the puerperium CLINICAL CASE: We present the case of a 37-year-old female patient with a 31.1-week pregnancy who was referred to our hospital for preeclampsia with severity data with biochemical alterations and difficult control of blood pressure figures. In the immediate postoperative period, the patient develops acute abdominal pain with free fluid in the abdominal ultrasound. This procedure is followed by an emergency laparotomy, with a lesion of approximately 3 cm in the lower pole and splenic hilum performing emergency splenectomy. The postoperative period was uneventful and the patient was discharged 8 days after surgery. CONCLUSIONS: The diagnosis and timely management of splenic rupture in the puerperium associated with Preeclampsia prevents maternal death.

Multicenter clinical research of splenic autotransplantation / 实用医学杂志

Objective To investigate the clinical value of splenic autotransplantation in patients with severe splenic trauma. Methods A prospective case-control study were performed in 120 patients with traumatic spleen rupture including the treatment group 72 patients and the control group 48 patients. The treatment group were treated with splenectomy plus spleen autotransplantation and the control group merely under splenectomy. Compare the operation time,operative blood loss,postoperative hospital stay,postoperative complications and the immune indexes before and different period after operation. Results Autologous spleen transplantation takes more time than merely splenectomy(P<0.05),but the operative blood loss,postoperative hospital stay and postopera-tive complications were no significant difference. 1 days after operation,the immune indexes of two groups were significantly lower than those before operation(P < 0.05),and 1 week after operation the immune indexes of two groups were significantly elevated(P<0.05).The immune indexes of the treatment group were better than those of the control group 3 months after operation(P < 0.05),and there was no significant difference compared with preoperative. Conclusion Splenectomy cause the decrease in the immune function,but the immune function can quickly rise to a certain level in short term.The splenic autotransplantation can effectively restore the immune func-tion to the preoperative level.

Traumatic splenic rupture, conservative vs surgical therapy / 中华普通外科杂志

Objective To evaluate management stratagy for patients with traumatic splenic rupture.Methods The clinical data of 124 patients with traumatic splenic rupture admitted to the 422 Hospital of PLA from April 2008 to June 2016 were retrospectively analyzed.38 patients were treated conservatively,while 86 patients underwent surgery.To investigate impact factors of management strategy in patients with traumatic splenic rupture,clinical characteristics and CT features between the two groups were compared.Results Univariate analysis results showed that injury causes,blood pressure,at admission,pulse,CT grade and abdominocentesis were closely related with therapeutic scheme.And multivariate Logistic regression analysis results showed that pulse (OR =4.264,95％ CI 1.206-15.073),CT grade (OR =2.086,95％ CI 1.019-4.271) and abdominocentesis (OR =3.428,95％ CI 1.024-11.479) were the significant determining factors of therapeutic scheme in patients with traumatic splenic rupture.Surgical intervention was carried out in 86 patients accounting for 69.4％ of all patients.The rate of surgical intervention was 58.1％ in the patients with CT grade of 1 and 2,that was 94.7％ in patients with CT grade of 3 and 4.Conclusions Operative management is needed for most traumatic splenic rupture,patients those with hemodynamic stability and CT grade of 1 or 2 may be qualified for watchful non-operative management.