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.

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.

Incidental splenic injury and splenectomy: an overview based on available evidence / Lesión esplénica incidental y esplenectomía: una visión general basada en la evidencia disponible

Splenectomy indications are hematologic disease, traumatic damage and iatrogenic injury. The aim of this study was to present an evidence-based overview of some clinical aspects of interest related with iatrogenic splenic injury and subsequent splenectomy. An overview of the available evidence was conducted. Articles that evaluated clinical aspects of interest related with iatrogenic splenic injury and subsequent splenectomy, without language limits, publication date and designs. BVS, PubMed, SciELO and TRIP databases were reviewed. Evaluated variables were: Frequency and etiology of surgical spleen injuries, treatment options, frequency of splenectomy, associated postoperative morbidity (POM) and mortality, recommendation for splenectomy. Classification of the available evidence was made using the classification proposed by Oxford Centre of Evidence-based Medicine. 1144 records were obtained. 1109 were discarded for not meeting eligibility criteria, or were not relevant for the purpose of this research. Finally, the study consisted of 35 articles, 3 of evidence level type 3a, 31 of evidence level type 4 and 1 of evidence level type 5. Splenectomy is a complication of common abdominal procedures, prevalence and incidence of iatrogenic splenic injury is underestimated because of lack of information, there is evidence of risk factors of surgical spleen injuries, the etiology of surgical spleen injuries are bariatric, esophago-gastric, antireflux, colorectal, abdominal vascular and urological procedures. POM in patients undergoing splenectomy is more frequent in emergency splenectomy secondary to trauma. There was no significant risk reduction of infectious complications after implementation of routine vaccination. Available evidence is based on few and heterogeneous articles, which make a meaningful conclusions difficult. Studies with better evidence levels, methodological quality and population size are needed for conclusions and recommendations.

Las indicaciones de esplenectomía son enfermedades hematológicas, daño por trauma y por lesiones iatrogénicas. El objetivo de este estudio es presentar una visión general basada en la evidencia actualmente disponible, respecto de algunos aspectos clínicos de interés relacionados con la lesión esplénica iatrogénica y posterior esplenectomía. Revisión global de la evidencia disponible. Se incluyeron artículos que evaluaron aspectos clínicos de interés relacionados con lesión esplénica iatrogénica y posterior esplenectomía; sin límites de lenguaje, fecha de publicación y diseño. Se revisaron las bases de datos BVS, PubMed, SciELO y Trip Database. Las variables evaluadas fueron: frecuencia y etiología de las lesiones, opciones de tratamiento, frecuencia de esplenectomía, morbimortalidad postoperatoria, recomendación de esplenectomía. La clasificación de la evidencia se realizó con la propuesta del Centro de Medicina Basada en la Evidencia de Oxford. Se obtuvieron 1144 registros. 1109 fueron descartados por no cumplir criterios de elegibilidad, o ser no relevantes para el objetivo de la investigación. La población en estudio quedó compuesta por 35 artículos, 3 de nivel de evidencia 3a, 31 de nivel de evidencia 4 y 1 de nivel de evidencia 5. La esplenectomía es una complicación propia de la cirugía abdominal. La prevalencia e incidencia de lesión esplénica iatrogénica es subestimada por falta de información. Hay evidencia de factores de riesgo de lesiones del bazo. La etiología de estas es: procedimientos bariátricos, esófago-gástricos, colorrectales, vasculares abdominales y urológicos. La morbilidad es más frecuente en esplenectomía de emergencia secundaria a trauma. No se ha registrado disminución significativa del riesgo de complicaciones infecciosas con la vacunación rutinaria. La evidencia disponible se basa en pocos artículos y heterogéneos, lo que impide sacar conclusiones. Se necesitan estudios de mejor nivel de evidencia, calidad metodológica y tamaño de muestra para obtener conclusiones válidas y recomendaciones adecuadas.

Spontaneous Splenic Rupture in a Vivax Malaria Case Treated with Transcatheter Coil Embolization of the Splenic Artery

An enlarged spleen is considered one of the most common signs of malaria, and splenic rupture rarely occurs as an important life-threatening complication. Splenectomy has been recommended as the treatment of choice for hemodynamically unstable patients. However, a very limited number of splenic rupture patients have been treated with transcatheter coil embolization. Here we report a 38-year-old Korean vivax malaria patient with ruptured spleen who was treated successfully by embolization of the splenic artery. The present study showed that angiographic embolization of the splenic artery may be an appropriate option to avoid perioperative harmful effects of splenectomy in malaria patients.

Torsion of wandering spleen and resulting rupture of splenic hilum with whorled sign in CT: a case report

Torsion of a wandering spleen is an atypical cause of an acute abdomen. Herein we report a case of a wandering spleen in a 24 year-old female patient who presented with vague clinical findings of acute abdomen, a laparotomy was performed and the infracted spleen was removed. In such cases, prompt intervention to prevent complications is mandatory

Fatal splenic rupture caused by an atypical malignant lymphoma in a Holstein cow

Postmortem examination of a 5.5-year-old Holstein cow with history of sudden death showed a very huge spleen [120 x 45 x 10 cm] associated with severe haemoperitoneum. Histopathological findings included extensive infiltration of medium to large sized lymphocytic and lymphoblastic cells with small amounts of cytoplasm, round nuclei with coarsely granular chromatin in the spleen, and limited foci of similar cellular infiltration in the liver. This case was diagnosed as a fatal splenic rupture caused by an atypical malignant lymphoma

Spontaneous splenic rupture due to dengue fever: report of two cases

Dengue is a febrile illness caused by Flavivírus and mainly transmitted by the mosquito Aedes aegypiti which have been a serious epidemic in Rio de Janeiro. In most of cases it was a self limited disease. We report two cases of a serious and rare complication of this viral infection.

Splenic complications in malaria: a case series.

Splenic complications in malaria may be either simple asymptomatic enlargement or serious conditions, such as splenic infarction, rupture, hematoma or abscess, which can be fatal. Only a few cases have been reported in the literature since 1960. The true incidence of splenic complications is not known because of underdiagnosis and underreporting. We report here four cases which were successfully treated conservatively.

Spontaneous rupture of malarial spleen.

Spontaneous rupture of malarial spleen is uncommon even in highly endemic areas of malaria. We report an eight year old girl who presented with spontaneous splenic rupture following malaria. She recovered with conservative management.

Splenic rupture as a complication of colonoscopy.

Splenic rupture is a rare but potentially lethal complication of colonoscopy. We report a 66-year-old man who developed abdominal pain 6 hours after diagnostic colonoscopy. His clinical status deteriorated rapidly. Splenic rupture was identified at laparotomy. He recovered after surgery.

Ruptura esplénica espontanea secundaria a amiloidosis / Spontaneous splenic rupture due to amyloidosis

La ruptura esplénica se produce frecuentemente por mecanismos traumáticos. Se la denomina espontánea o patológica cuando no existe tal antecedente o hay alguna patología esplênica predisponente. La ruptura esplénica espontánea por infiltración amiloide es una causa muy infrecuente de abdômen agudo quirúrgico. Se presenta el caso de una mujer internada por abdomen agudo secundario a ruptura esplénica espontánea, cuyo diagnóstico final fue amiloidosis primaria.

Lesão esplênica por projétil de arma de fogo / Splenic injuries by firearms projectile

Entre janeiro de 1984 e dezembro de 1994 foram operados 560 pacientes com ferida abdominal penetrante por projétil de arma de fogo (PAF) no Serviço de Emergência (SE) do Hospital Universitário Antônio Pedro (HUAP), da Universidade Federal Fluminense (UFF). Destes, 59 (10,53 por cento) apresentaram lesão esplênica (LE). Sete pacientes faleceram durante o ato cirúrgico. Dos 52 casos estudados, 94 por cento eram do sexo masculino e 86,5 por cento estavam na faixa etária compreendida entre 13 e 40 anos. A incisão utilizada foi a laparotomia mediana na totalidade dos pacientes. As lesões associadas intra-abdominais mais freqüentes foram no estômago em 25 casos (48,1 por cento), no diagragma em 19 casos (36,5 por cento) e no fígado em 14 (26,9 por cento). A lesão isolada do baço foi encontrada em sete casos (13,4 por cento). Em 48,1 por cento dos casos as lesões foram classificadas como graus II e III da escala de gravidade da Organ Injury Scaling (OIS) (13). A esplenectomia total (ET) foi realizada em 28 pacientes (53,8 por cento) e a cirurgia conservadora em 24 (46,1 por cento) O abscesso subfrênico foi a complicação pós-operatória mais encontrada, em três casos (6,67 por cento). Dois pacientes faleceram, sendo um por pancreatite e hemorragia pós-sutura das lesões esplênicas (SLE) e o outro por síndrome da angústia respiratória do adulto (SARA). O tempo de permanência hospitalar variou entre cinco e 58 dias. A média de transfusão sangüínea foi de 4,6 unidades para pacientes co LE associada com outas lesões abdominais e de 0,9 unidade para pacientes com lesão isolada de baço.

Abscesso esplênico associado à pileflebite / Splenic abscess and pylephlebitis

Neste artigo, descrevemos o caso de um paciente masculino de 46 anos tratado em nosso Serviço com diagnóstico de abscesso esplênico associado à pileflebite. A apresentaçäo clínica, o diagnóstico, a etiologia e o tratamento dos abscessos esplênicos säo revisados. Discute-se a repercussäo da pileflebite no tratamento e na evoluçäo deste caso.

Spontaneous splenic rupture secondary to metastatic gastric carcinoma.

Spontaneous rupture of the spleen secondary to metastatic carcinoma is rare. We report the second such case. Rupture is usually diagnosed at laparotomy. However ultrasound and computerized tomography can play a role in diagnosis.