RESUMEN
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.
Asunto(s)
Fracturas Óseas , Rotura del Bazo , Tromboembolia Venosa , Humanos , Heparina de Bajo-Peso-Molecular/uso terapéutico , Tromboembolia Venosa/etiología , Tromboembolia Venosa/prevención & control , Aspirina/uso terapéutico , Pérdida de Sangre Quirúrgica , Estudios Retrospectivos , Fracturas Óseas/cirugía , Anticoagulantes/uso terapéutico , Rotura del Bazo/inducido químicamente , Rotura del Bazo/complicaciones , Rotura del Bazo/tratamiento farmacológico , Hematoma , Extremidad Inferior/cirugía , Heparina/efectos adversosRESUMEN
Amyloid light chain (AL) amyloidosis is a protein conformational disease. AL amyloidosis results from aggregation of misfolded proteins that are deposited in tissues as amyloid fibrils. Diagnosis of AL amyloidosis can be challenging due to its low incidence and clinical complexity. Therapy requires a risk-adapted approach involving dose reductions and schedule modifications of chemotherapy regimens along with close monitoring of hematologic and organ responses. We herein describe a patient whose condition was diagnosed as systemic AL amyloidosis and presented with splenic rupture as the initial symptom. Congo red staining of the kidney biopsy was positive. The normal structure of the liver and spleen had been replaced by amyloid deposition. The chemotherapy strategy involved a combination of bortezomib, cyclophosphamide, thalidomide, and dexamethasone.
Asunto(s)
Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas/patología , Hepatopatías/patología , Rotura del Bazo/patología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Humanos , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas/complicaciones , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas/tratamiento farmacológico , Hepatopatías/complicaciones , Hepatopatías/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Pronóstico , Rotura del Bazo/complicaciones , Rotura del Bazo/tratamiento farmacológicoRESUMEN
Babesiosis is a relatively common tick-borne parasitic infection of erythrocytes primarily affecting the northeastern United States. Babesiosis' prevalence and presentation have earned it the monikers "malaria of the northeast" and "Nantucket fever". Clinical presentation ranges from asymptomatic infection to severe infection including acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulopathy (DIC) or death. Since 2008, there have been a number of reports of splenic rupture in patients with the disease. We seek to provide a further understanding of this process, with the report of a case of splenic rupture followed by a systematic review of the current literature. We found that 87% of splenic rupture secondary to babesiosis occurred in male patients who are otherwise healthy, with an average of 56 years. Computed tomography is a reliable mode of diagnosis, and hemoperitoneum is the most common imaging finding. Patients with splenic rupture due to human babesiosis were successfully treated by various management strategies, such as conservative non-operative approach, splenic artery embolization, and splenectomy. The modality of treatment depends on patient's clinical course and hemodynamic stability, although spleen conserving strategy should be considered first whenever possible.
Asunto(s)
Antiparasitarios/uso terapéutico , Babesiosis/complicaciones , Clindamicina/uso terapéutico , Quinina/uso terapéutico , Rotura del Bazo/parasitología , Babesiosis/tratamiento farmacológico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores Sexuales , Rotura del Bazo/tratamiento farmacológico , Resultado del TratamientoRESUMEN
A 50-year-old man was diagnosed with multiple myeloma complicating AL amyloidosis. Splenic rupture was complicated during autologous stem cell transplantation (auto-SCT). Granulocyte colony-stimulating factor (G-CSF) was not administered. A pathological examination of the spleen revealed that CD34-positive cells were concentrated in the ruptured part of the splenic capsule. Hematopoietic cells were engrafted in the small gap between the capsule and amyloid protein deposition area of the spleen, which might have caused the splenic rupture in the absence of G-CSF administration. Special attention is thus required for amyloidosis patients undergoing auto-SCT, even when G-CSF is not administered.
Asunto(s)
Antineoplásicos/uso terapéutico , Bortezomib/uso terapéutico , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas/complicaciones , Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas/tratamiento farmacológico , Mieloma Múltiple/complicaciones , Rotura del Bazo/tratamiento farmacológico , Trasplante Autólogo/efectos adversos , Factor Estimulante de Colonias de Granulocitos , Hematopoyesis Extramedular , Humanos , Masculino , Persona de Mediana Edad , Mieloma Múltiple/terapia , Rotura del Bazo/etiologíaRESUMEN
Light-chain deposition disease (LCDD) is a rare plasma cell neoplasm that secretes an abnormal immunoglobulin light chain, which is deposited in tissues, leading to organ dysfunction. Spontaneous splenic rupture is a rare and life-threatening complication of treatment with granulocyte colony-stimulating factor (G-CSF). Herein, we describe spontaneous splenic rupture after the administration of lenograstim to a patient with LCDD undergoing autologous stem cell transplantation (ASCT). The patient was successfully treated by transcatheter embolization of the splenic artery, and long-term stringent complete remission was attained. Plasma cell neoplasms, including multiple myeloma with amyloidosis, are among the most commonly reported conditions associated with spontaneous splenic rupture in patients undergoing ASCT. This finding suggests that, in addition to the effect of G-CSF on the spleen, a combination of factors, including tissue vulnerability induced by the infiltration of abnormal immunoglobulins, may be involved in the pathogenesis of spontaneous splenic rupture. Notably, splenomegaly is not always evident in these patients. Surgical treatment may not be an option, because of severe myelosuppression, and thus less invasive treatment using transcatheter embolization may be feasible.
Asunto(s)
Paraproteinemias/complicaciones , Trasplante de Células Madre de Sangre Periférica/efectos adversos , Rotura Espontánea/etiología , Rotura del Bazo/etiología , Femenino , Humanos , Persona de Mediana Edad , Rotura Espontánea/tratamiento farmacológico , Rotura del Bazo/tratamiento farmacológico , Trasplante Autólogo/efectos adversos , Resultado del TratamientoRESUMEN
Splenic abscesses are increasingly being identified, possibly due to widespread use of imaging modalities in clinical practice. The commonest clinical features are high grade fever and exclusively localised left upper quadrant abdominal pain. These symptoms are similar to most infectious diseases prevalent in the tropics, making imaging by ultrasonography or computer tomography a necessity in the diagnosis. There are reports from different geographic areas on splenic abscesses associated with typhoid fever. We reported ruptured splenic abscess presenting with peritonitis as a rare and grave complication of typhoid fever.
Asunto(s)
Absceso Abdominal/microbiología , Peritonitis/microbiología , Rotura del Bazo/microbiología , Fiebre Tifoidea/complicaciones , Absceso Abdominal/diagnóstico por imagen , Absceso Abdominal/tratamiento farmacológico , Absceso Abdominal/cirugía , Adulto , Antibacterianos/uso terapéutico , Humanos , Masculino , Peritonitis/diagnóstico por imagen , Peritonitis/tratamiento farmacológico , Peritonitis/cirugía , Rotura del Bazo/diagnóstico por imagen , Rotura del Bazo/tratamiento farmacológico , Rotura del Bazo/cirugía , Tomografía Computarizada por Rayos X , Fiebre Tifoidea/diagnóstico por imagen , Fiebre Tifoidea/tratamiento farmacológico , UltrasonografíaRESUMEN
The study presented two cases of spontaneous rupture of the spleen. Both patients were treated at the Department of General, Oncological, and Endocrinological Surgery. The first patient underwent splenectomy. The postoperative course was uneventful. The second patient was subject to pharmacological treatment because of non-acceptance to surgical intervention. The patient died during the following hospitalization. Both patients received oral anticoagulants, due to atrial fibrillation and an implanted heart valve. History of previous trauma was absent. The study presented a detailed description of the clinical course of splenic rupture.
Asunto(s)
Rotura del Bazo/diagnóstico , Rotura del Bazo/terapia , Dolor Abdominal/etiología , Resultado Fatal , Hemoperitoneo/etiología , Humanos , Masculino , Persona de Mediana Edad , Enfermedades Raras , Rotura Espontánea , Esplenectomía , Rotura del Bazo/tratamiento farmacológico , Rotura del Bazo/cirugía , Resultado del TratamientoAsunto(s)
Factor Estimulante de Colonias de Granulocitos/efectos adversos , Mieloma Múltiple/terapia , Trasplante de Células Madre de Sangre Periférica , Rotura del Bazo/complicaciones , Rotura del Bazo/tratamiento farmacológico , Adulto , Femenino , Filgrastim , Factor Estimulante de Colonias de Granulocitos/administración & dosificación , Humanos , Polietilenglicoles , Proteínas Recombinantes , Factores de Riesgo , Rotura Espontánea , Rotura del Bazo/diagnóstico , Trasplante Autólogo , Resultado del TratamientoAsunto(s)
Leishmania donovani/aislamiento & purificación , Leishmaniasis Visceral/complicaciones , Rotura del Bazo/microbiología , Anciano , Animales , Antiprotozoarios/uso terapéutico , Humanos , Leishmaniasis Visceral/diagnóstico , Leishmaniasis Visceral/tratamiento farmacológico , Masculino , Meglumina/uso terapéutico , Antimoniato de Meglumina , Compuestos Organometálicos/uso terapéutico , Radiografía , Rotura Espontánea , Bazo/diagnóstico por imagen , Bazo/microbiología , Rotura del Bazo/diagnóstico por imagen , Rotura del Bazo/tratamiento farmacológico , Resultado del TratamientoRESUMEN
We describe the first case of spontaneous splenic rupture associated with tinzaparin in a cancer patient. This low-molecular-weight heparin was administrated for deep venous thrombosis and pulmonary embolism. No underlying splenic pathology predisposing to this condition was found.
Asunto(s)
Anticoagulantes/efectos adversos , Fibrinolíticos/efectos adversos , Hemoperitoneo/inducido químicamente , Heparina de Bajo-Peso-Molecular/efectos adversos , Rotura del Bazo/inducido químicamente , Anciano , Anticoagulantes/administración & dosificación , Carcinoma de Células Pequeñas/tratamiento farmacológico , Carcinoma de Células Pequeñas/patología , Femenino , Fibrinolíticos/administración & dosificación , Hemoperitoneo/diagnóstico por imagen , Hemoperitoneo/tratamiento farmacológico , Heparina de Bajo-Peso-Molecular/administración & dosificación , Humanos , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/patología , Embolia Pulmonar/tratamiento farmacológico , Radiografía , Rotura Espontánea , Rotura del Bazo/diagnóstico por imagen , Rotura del Bazo/tratamiento farmacológico , Factores de Tiempo , Tinzaparina , Resultado del Tratamiento , Trombosis de la Vena/tratamiento farmacológicoAsunto(s)
Leucemia Linfocítica Crónica de Células B/complicaciones , Rotura del Bazo/etiología , Dolor Abdominal/etiología , Antineoplásicos/administración & dosificación , Humanos , Leucemia Linfocítica Crónica de Células B/tratamiento farmacológico , Leucemia Linfocítica Crónica de Células B/patología , Masculino , Persona de Mediana Edad , Rotura del Bazo/diagnóstico por imagen , Rotura del Bazo/tratamiento farmacológico , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Although underreported, histologic splenic involvement in Wegener's granulomatosis (WG) is not unusual. Splenic rupture in association with WG, however, is rare. Only 2 cases of nontraumatic splenic rupture have been reported as the initial feature of WG. Isolated cases of splenic rupture also have been noted in rheumatoid arthritis, systemic lupus erythematosus, and polyarteritis nodosa. OBJECTIVE: To report the third case of splenic rupture as the presenting feature of WG and review the literature concerning splenic rupture in other rheumatologic diseases to better delineate a mechanism for this rare occurrence. METHODS: Descriptive case report of 1 patient with WG with antecedent splenic rupture and a review of the relevant literature using a MEDLINE search from 1950 to 2001. RESULTS: Our patient presented with symptoms and signs of WG 2 weeks after nontraumatic splenic rupture. Two similar cases have been reported: one showed splenic vasculitis histologically and the other only a neutrophilic infiltration at the site of the splenic tear and subcapsular zone after surgery. Although splenic capsular and pulp hemorrhage alone without signs of vasculitis were noted in our patient, no other cause (ie, hematologic, infectious, neoplastic, or otherwise) for splenic rupture was found. CONCLUSIONS AND RELEVANCE: As in the 2 reported cases, WG may have been responsible for splenic rupture in our patient. Regardless, early evaluation for connective tissue disease in a patient with spontaneous splenic rupture without apparent cause merits consideration, as it may affect patient follow-up and treatment.
Asunto(s)
Granulomatosis con Poliangitis/diagnóstico , Rotura del Bazo/diagnóstico , Administración Oral , Anciano , Ciclofosfamida/uso terapéutico , Granulomatosis con Poliangitis/complicaciones , Granulomatosis con Poliangitis/tratamiento farmacológico , Humanos , Inmunosupresores/administración & dosificación , Inmunosupresores/uso terapéutico , Masculino , Prednisona/uso terapéutico , Rotura del Bazo/tratamiento farmacológico , Rotura del Bazo/etiología , Resultado del TratamientoRESUMEN
A 13-year-old haemophilia A patient presented with pain in the abdomen, 4 days after a blunt abdominal trauma. The computed tomography scan of the abdomen showed a large splenic haematoma. The patient was initially managed with factor VIII replacement therapy, but 4 weeks later he had a delayed rupture of the splenic haematoma with haemoperitoneum and shock. An elective splenectomy under factor VIII therapy was successfully performed.
Asunto(s)
Hematoma/cirugía , Hemofilia A/cirugía , Rotura del Bazo/cirugía , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/diagnóstico por imagen , Traumatismos Abdominales/cirugía , Adolescente , Pérdida de Sangre Quirúrgica/prevención & control , Factor VIII/administración & dosificación , Hematoma/diagnóstico por imagen , Hematoma/etiología , Hemofilia A/complicaciones , Hemofilia A/tratamiento farmacológico , Humanos , Masculino , Radiografía , Esplenectomía , Rotura del Bazo/tratamiento farmacológico , Rotura del Bazo/etiologíaAsunto(s)
Absceso/microbiología , Infecciones por Bacteroides/microbiología , Bacteroides fragilis/aislamiento & purificación , Peritonitis/microbiología , Rotura del Bazo/microbiología , Absceso/tratamiento farmacológico , Absceso/fisiopatología , Anciano , Anciano de 80 o más Años , Infecciones por Bacteroides/tratamiento farmacológico , Infecciones por Bacteroides/fisiopatología , Femenino , Humanos , Peritonitis/tratamiento farmacológico , Peritonitis/fisiopatología , Rotura del Bazo/tratamiento farmacológico , Rotura del Bazo/fisiopatología , Tomografía Computarizada por Rayos XRESUMEN
Angiosarcoma of the spleen is a rare disease, and the prognosis of this disease is extremely unfavorable. We herein review the case of a 45-year-old Japanese woman, who received a combined chemotherapy with cyclophosphamide, Adriamycin, vincristine, and prednisone after splenectomy and experienced a good response. The various types of chemotherapy for this disease are also discussed with references to the above case because no effective chemotherapeutic protocol for angiosarcomas has yet to be established.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Hemangiosarcoma/tratamiento farmacológico , Neoplasias del Bazo/tratamiento farmacológico , Rotura del Bazo/tratamiento farmacológico , Terapia Combinada , Ciclofosfamida/administración & dosificación , Doxorrubicina/administración & dosificación , Femenino , Hemangiosarcoma/complicaciones , Hemangiosarcoma/patología , Hemangiosarcoma/cirugía , Humanos , Persona de Mediana Edad , Metástasis de la Neoplasia , Cuidados Posoperatorios , Prednisona/administración & dosificación , Rotura Espontánea , Esplenectomía , Neoplasias del Bazo/complicaciones , Neoplasias del Bazo/patología , Neoplasias del Bazo/cirugía , Rotura del Bazo/etiología , Rotura del Bazo/patología , Rotura del Bazo/cirugía , Vincristina/administración & dosificaciónRESUMEN
Les traumatismes de la rate ont quelques fois pose de difficiles problemes de diagnostic et d'indications operatoires pour le chirurgien generaliste. Ces dernieres annees; deux grandes tendances se degagent de nombreuses publications consacrees a ce sujet : une precision diagnostique de plus en plus grande liee a l'amelioration des techniques d'imagerie medicale; et une attitude therapeutique de moins en moins agressive; c'est-a-dire de moins chirurgicale; liee egalement a la precision du diagnostic et a un meilleur suivi des patients. Devant l'engouement que peut susciter cette derniere tendance therapeutique chez les chirurgiens des milieux sous-equipes comme ceux du Zaire; il a paru interessant de faire une mise au point afin de degager l'attitude therapeutique la mieux adaptee a cet environnement
Asunto(s)
Bazo , Rotura del Bazo/tratamiento farmacológico , Rotura del Bazo/cirugía , Heridas y LesionesRESUMEN
A recent case of posttraumatic splenic abscess in a young man following nonoperative management of his splenic rupture is reported. With the recent trend toward nonoperative management of hemodynamically stable splenic rupture, the potential complications of splenic abscess may become more common. In view of the high mortality associated with unrecognized splenic abscess, it is important for the clinician to be aware of this entity.