Atraumatic splenic rupture secondary to granulocyte-colony stimulating factor medication exposure.

Hematopoietic hormones such as granulocyte-colony stimulating factors are commonly used prevent neutropenia in patients undergoing chemotherapy and to prepare patients for bone marrow donations. In rare cases, splenic injury can result from exposure to this medication. We present the case of a 30-year-old man who presented to the emergency department the day after a bone marrow donation procedure complaining of severe, acute onset left upper quadrant abdominal pain, radiating to the shoulder. Neither the patient nor his family reported any abdominal trauma prior to or following the marrow donation procedure. An initial bedside ultrasound examination was positive for peritoneal fluid and distortion of the normal splenic architecture, raising suspicion for possible intraabdominal or splenic injury. An emergent confirmatory CT with contrast of the abdomen confirmed the initial ultrasound examination suspicion of an atraumatic splenic rupture and with evidence of venous bleeding but without active arterial extravasation. An emergent trauma surgery consultation was placed, and he underwent embolization with an uneventful recovery. This case report highlights the need for a high index of suspicion for atraumatic splenic rupture in patients exposed to these types of granulocyte-colony stimulating factors.

Utilization of point-of-care ultrasound to evaluate for enterovesical fistula.

Enterovesical fistula formation is a relatively rare disease process although a common complication for patients with inflammatory bowel disease (IBD), notably Crohn's disease. Enterovesical fistulas most commonly arise from diverticulitis (65-80%), cancer (10-20%), or Crohn's disease (5-7%). An increasing amount of evidence supports the use of ultrasonography as the primary imaging method for the monitoring of complications in individuals with a documented history of IBD. Our case report presents a 30-year-old female with a history of Crohn's disease who presented to the Emergency Department with concern for possible enterovesical fistula formation. Using bedside gray-scale ultrasonography, a fistulous tract clearly visualizing air bubbles and fecal matter actively moving from bowel to the bladder through the fistula was visualized confirming the diagnosis of an enterovesical fistula. While CT imaging is instrumental in identifying mural and extramural complications of IBD, performing ultrasonography in patients with IBD serves as an efficient, inexpensive, and noninvasive diagnostic aid for the diagnosis of enterovesical fistula.