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1.
Am J Emerg Med ; 80: 228.e1-228.e4, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38677911

ABSTRACT

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.


Subject(s)
Granulocyte Colony-Stimulating Factor , Splenic Rupture , Humans , Male , Splenic Rupture/chemically induced , Splenic Rupture/etiology , Splenic Rupture/diagnostic imaging , Adult , Granulocyte Colony-Stimulating Factor/therapeutic use , Tomography, X-Ray Computed , Embolization, Therapeutic/methods , Ultrasonography
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 36(11): 1381-1387, 2022 Nov 15.
Article in Chinese | MEDLINE | ID: mdl-36382456

ABSTRACT

Objective: To investigate the effectiveness and safety of low molecular weight heparin combined with aspirin for perioperative prophylactic anticoagulation in patients with lower extremity fracture after splenectomy. Methods: The clinical data of 50 patients with splenic rupture combined with lower extremity fracture between January 2009 and June 2022 were retrospectively analyzed. All patients were given enoxaparin sodium at 48 hours after splenectomy, and stopped at 24 hours before fracture surgery. After fracture surgery, the patients were divided into aspirin group (group A, 15 cases), low molecular weight heparin group (group B, 16 cases), and low molecular weight heparin combined with aspirin group (group C, 19 cases) according to different anticoagulation regimens. The treatment course was 28 days. There was no significant difference in gender, age, body mass index, cause of injury, fracture site, time from injury to operation, complications, and other general data between groups ( P>0.05). The occurrence of venous thromboembolism (VTE) was observed; hemoglobin (Hb), platelet (PLT), D-D dimer, and fibrinogen degradation product (FDP) were recorded before operation and at 1, 3, and 7 days after operation, and the effect of anticoagulation regimen on coagulation function was observed. The incidences of wound complications and bleeding related complications were recorded, and the total perioperative blood loss, hidden blood loss, and overt blood loss were calculated. Results: The incidences of VTE in groups A, B, and C were 13.33% (2/15), 12.50% (2/16), and 5.26% (1/19), respectively, and there was no significant difference between groups ( χ 2=0.770, P=0.680). There was no portal vein thrombosis and no VTE-related death in the 3 groups. There was no significant difference in the levels of Hb, PLT, D-D dimer, and FDP between groups before and after operation ( P>0.05); and there was no significant difference in total perioperative blood loss, hidden blood loss, and overt blood loss between groups ( P>0.05). No local skin necrosis was found in all patients. In group A, 1 case occurred redness and swelling of incision; in group B, 1 case had incision discharge, redness, and swelling, and 1 case had fat liquefaction; in group C, 1 case had repeated incision exudation accompanied by local tissue redness and swelling, and 1 case had local hematoma. The incidences of adverse incision in groups A, B, and C were 6.66% (1/15), 12.50% (2/16), and 11.76% (2/19), respectively, with no significant difference ( χ 2=0.302, P=0.860). There were 4 cases of bleeding related complications, including 1 case of incision ecchymosis in groups A and B respectively, with the incidence of 6.66% and 6.25%, respectively; there was 1 case of incision hematoma and 1 case of bleeding in group C, with the incidence of 11.76%; showing no significant difference in the incidence of bleeding related complications between groups ( χ 2=0.268, P=0.875). Conclusion: Perioperative combined use of low molecular weight heparin and aspirin for prevention of anticoagulation in patients with splenic rupture and lower extremity fracture can effectively prevent the occurrence of VTE without increasing the incidence of complications, which is an effective and safe treatment method. However, whether the incidence of VTE can be reduced needs to be further studied by expanding the sample size.


Subject(s)
Fractures, Bone , Splenic Rupture , Venous Thromboembolism , Humans , Heparin, Low-Molecular-Weight/therapeutic use , Venous Thromboembolism/etiology , Venous Thromboembolism/prevention & control , Aspirin/therapeutic use , Blood Loss, Surgical , Retrospective Studies , Fractures, Bone/surgery , Anticoagulants/therapeutic use , Splenic Rupture/chemically induced , Splenic Rupture/complications , Splenic Rupture/drug therapy , Hematoma , Lower Extremity/surgery , Heparin/adverse effects
4.
J Investig Med High Impact Case Rep ; 9: 23247096211026492, 2021.
Article in English | MEDLINE | ID: mdl-34148386

ABSTRACT

Splenic rupture due to any cause is a life-threatening complication and commonly attributed to trauma. Atraumatic splenic rupture is very rarely reported, and the incidence is currently unknown. Anticoagulants and dual anti-platelet medication can increase the chances of a splenic rupture. Surgical removal of the spleen may be warranted to prevent a life-threatening bleeding. Early identification and intervention are required for most patients as only a few qualify for medical management.


Subject(s)
Platelet Aggregation Inhibitors , Splenic Rupture , Humans , Platelet Aggregation Inhibitors/adverse effects , Pyrazoles , Pyridones/adverse effects , Rupture, Spontaneous , Splenic Rupture/chemically induced , Splenic Rupture/diagnostic imaging
6.
Am J Emerg Med ; 38(5): 1044.e1-1044.e2, 2020 05.
Article in English | MEDLINE | ID: mdl-31932128

ABSTRACT

Novel oral anticoagulants (NOACs) are increasingly popular. Spontaneous splenic rupture is rare and life-threatening, especially if it is not immediately recognized. Prior work has demonstrated an association with NOAC use and spontaneous splenic rupture in unusual clinical circumstances. We present the case of spontaneous splenic hemorrhage in a largely healthy 57-year old female who was recently started on apixiban for a provoked PE. She had been discharged from an outside facility, and presented just hours after discharge to our emergency department in extremis: unconscious, pale, hypotensive, and tachycardic. Her abdomen on arrival was noted to be distended with positive fluid wave, and bedside ultrasound confirmed massive peritoneal fluid. Prompt diagnostic peritoneal aspirate confirmed hemoperitoneum, and a massive transfusion protocol was initiated. The patient's blood pressure and heart rate improved, and she was stabilized for imaging. Computed tomography demonstrated large subcapsular splenic hematoma with active extravasation at the periphery of the spleen. The patient was taken emergently to interventional radiology suite where splenic artery embolization was performed and an IVC filter was placed. She subsequently developed acute respiratory distress syndrome and persistent low urine output with hypotension despite resuscitation, and was taken to the operating room for splenectomy and abdominal washout. She improved thereafter and was discharged 12 days later. Prompt diagnosis and aggressive early resuscitation contributed to this patient's outcome.


Subject(s)
Anticoagulants/adverse effects , Hypotension/etiology , Pyrazoles/adverse effects , Pyridones/adverse effects , Splenic Rupture/chemically induced , Administration, Oral , Embolization, Therapeutic , Female , Hematoma/etiology , Hematoma/surgery , Humans , Middle Aged , Spleen , Splenectomy , Splenic Rupture/diagnostic imaging , Splenic Rupture/surgery , Tomography, X-Ray Computed , Ultrasonography
8.
Clin Med (Lond) ; 18(5): 406-408, 2018 10.
Article in English | MEDLINE | ID: mdl-30287437

ABSTRACT

We present the case of a 77-year-old woman who had an accidental fall in her garden, resulting in a fracture of her left ankle. After manipulation of the fracture, she developed sudden onset shortness of breath. An echo led to the diagnosis of Takotsubo cardiomyopathy. Shortly after this she developed sudden onset receptive and expressive dysphasia. Magnetic resonance imaging (MRI) of the head confirmed a left parietal infarct thought to be secondary to left ventricular thrombus formation. She was started on dabigatran. A few days later, she developed abdominal pain, and was subsequently diagnosed with a spontaneous splenic rupture. This case was interesting due to the unusual chain of events following a simple fall, and also a rare complication of anticoagulant therapy.


Subject(s)
Anticoagulants/adverse effects , Dabigatran/adverse effects , Splenic Rupture , Takotsubo Cardiomyopathy , Accidental Falls , Acute Disease , Aged , Ankle Fractures , Anticoagulants/therapeutic use , Dabigatran/therapeutic use , Female , Head/diagnostic imaging , Humans , Magnetic Resonance Imaging , Pulmonary Edema/diagnosis , Pulmonary Edema/etiology , Radiography, Abdominal , Splenic Rupture/chemically induced , Splenic Rupture/diagnosis , Splenic Rupture/physiopathology , Takotsubo Cardiomyopathy/blood , Takotsubo Cardiomyopathy/complications , Takotsubo Cardiomyopathy/diagnosis , Takotsubo Cardiomyopathy/drug therapy , Troponin/blood
9.
Drug Ther Bull ; 56(11): 136-139, 2018 Nov.
Article in English | MEDLINE | ID: mdl-30355723

ABSTRACT

In conjunction with BMJ Case Reports, DTB will feature occasional drug-related cases that are likely to be of interest to readers. These will include cases that involve recently marketed drugs for which there is limited knowledge of adverse effects and cases that highlight unusual reactions to drugs that have been marketed for several years.


Subject(s)
Factor Xa Inhibitors/adverse effects , Rivaroxaban/adverse effects , Splenic Rupture/chemically induced , Aged , Factor Xa Inhibitors/therapeutic use , Female , Humans , Rivaroxaban/therapeutic use , Thromboembolism/prevention & control
10.
BMJ Case Rep ; 20182018 Mar 05.
Article in English | MEDLINE | ID: mdl-29507024

ABSTRACT

In the prevention and treatment of thromboembolic disease, novel oral anticoagulants have emerged as alternatives to warfarin. A major challenge continues to be the reversal of their anticoagulant effect in the case of life-threatening haemorrhagic complications. We report a case of spontaneous splenic rupture treated by splenic artery embolisation in a 77-year-old woman who was anticoagulated with rivaroxaban.


Subject(s)
Factor Xa Inhibitors/adverse effects , Rivaroxaban/adverse effects , Splenic Rupture/chemically induced , Aged , Atrial Fibrillation/drug therapy , Female , Hemorrhage/etiology , Humans , Rupture, Spontaneous/chemically induced , Splenic Artery/surgery , Splenic Rupture/diagnostic imaging , Splenic Rupture/surgery
13.
J Med Case Rep ; 10(1): 217, 2016 Aug 09.
Article in English | MEDLINE | ID: mdl-27506776

ABSTRACT

BACKGROUND: Spontaneous splenic rupture associated with anticoagulant use is a rare but potentially lethal disorder. Lack of prompt recognition can be associated with poor patient outcomes. The use of novel oral anticoagulants is becoming more common and thus consideration of this disorder while evaluating a patient who presents with abdominal pain while using these agents is extremely important. This is the first reported case of spontaneous splenic rupture associated with apixaban. CASE PRESENTATION: We describe the clinical case of an 83-year-old white man who complained of sudden severe abdominal pain 5 days into a hospital stay for acute-on-chronic congestive heart failure and exacerbation of chronic obstructive pulmonary disease. Neither he nor his wife reported any significant trauma for the past 6 months prior to his admission. His medical history included chronic atrial fibrillation treated with medications including apixaban 2.5 mg twice daily. An urgent abdominal computed tomography scan demonstrated a large splenic hematoma and evidence of intraperitoneal bleeding from which he rapidly declined, developing hypovolemic shock. An emergency splenic arteriogram displayed a patent splenic artery and an embolization was successful in stabilizing him. Due to evidence of recurrent bleeding, an exploratory laparotomy and splenectomy was subsequently performed the following day. CONCLUSIONS: The diagnosis of spontaneous splenic rupture is important to consider in a patient using apixaban who presents with abdominal pain and associated signs of hypotension and anemia. For hemodynamically unstable patients, prompt treatment to stop significant bleeding through splenic artery embolization or splenectomy is warranted and may be lifesaving.


Subject(s)
Anticoagulants/adverse effects , Factor Xa Inhibitors/adverse effects , Pyrazoles/adverse effects , Pyridones/adverse effects , Splenic Rupture/chemically induced , Aged, 80 and over , Humans , Male , Rupture, Spontaneous/diagnostic imaging , Splenectomy , Splenic Rupture/diagnostic imaging , Splenic Rupture/surgery , Tomography, X-Ray Computed
16.
Am J Case Rep ; 17: 165-9, 2016 Mar 14.
Article in English | MEDLINE | ID: mdl-26972227

ABSTRACT

BACKGROUND: Rituximab is a therapeutic monoclonal antibody that is used for many different lymphomas. Post-marketing surveillance has revealed that the risk of fatal reaction with rituximab use is extremely low. Splenic rupture and cytokine release syndrome are rare fatal adverse events related to the use of therapeutic monoclonal antibodies, especially in aggressive malignancies with high tumor burden. CASE REPORT: A 55-year-old woman presented with abdominal pain and type B symptoms and was diagnosed with mantle cell lymphoma. Initial peripheral blood flow cytometry showed findings that mimicked features of chronic lymphocytic leukemia. Further treatment with rituximab led to catastrophic treatment complications that proved to be fatal for the patient. CONCLUSIONS: Severe cytokine release syndrome associated with biologics carries a very high morbidity and case fatality rate. With this case report we aim to present the diagnostic challenge with small B-cell neoplasms, especially mantle cell lymphoma and chronic lymphocytic lymphomas, and underscore the importance of thorough risk assessment for reactions prior to treatment initiation.


Subject(s)
Antineoplastic Agents/adverse effects , Cytokines/blood , Rituximab/adverse effects , Splenic Rupture/chemically induced , Fatal Outcome , Female , Humans , Lymphoma, Mantle-Cell/drug therapy , Middle Aged
17.
Med Arch ; 70(1): 69-71, 2016 Feb.
Article in English | MEDLINE | ID: mdl-26980937

ABSTRACT

INTRODUCTION: Stroke is a medical emergency in neurology, and is one of the leading causes of death nowadays. At a recent time, a therapeutic method used in adequate conditions is thrombolysis, a treatment of an emerging clot in the brain vascular system by alteplase. The application of alteplase also has a high risk of life threatening conditions. CASE REPORT: This is a brief report of a case with thrombolysis complication which manifested as a spleen rupture.


Subject(s)
Fibrinolytic Agents/adverse effects , Splenic Rupture/chemically induced , Splenic Rupture/diagnostic imaging , Stroke , Tissue Plasminogen Activator/adverse effects , Tomography, X-Ray Computed , Administration, Intravenous , Female , Fibrinolytic Agents/administration & dosage , Humans , Middle Aged , Rupture, Spontaneous , Splenectomy , Splenic Rupture/surgery , Stroke/drug therapy , Tissue Plasminogen Activator/administration & dosage , Treatment Outcome
19.
Am J Emerg Med ; 33(3): 478.e3-4, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25440002

ABSTRACT

Spontaneous spleen rupture with no recent report of trauma is an extremely rare and life-threatening cause of intraperitoneal hemorrhage.We present the first case of an atraumatic pathological splenic rupture following alteplase thrombolysis for ischemic stroke.


Subject(s)
Fibrinolytic Agents/adverse effects , Splenic Rupture/chemically induced , Stroke/drug therapy , Thrombolytic Therapy/adverse effects , Tissue Plasminogen Activator/adverse effects , Humans , Male , Middle Aged , Rupture, Spontaneous , Thrombectomy
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