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INTRODUCTION: Spontaneous splenic rupture is an atraumatic event that represents a rare and life-threatening acute complication in which the spleen is damaged producing internal hemorrhage in the abdominal cavity. Its association with hematologic malignancies, although a rare occurrence, has been previously described. Among this subset of patients, chronic myeloid leukemia is one of the main causes. PRESENTATION OF CASE: A 26-year-old male with history of chronic myeloid leukemia presented with acute intense abdominal right lower quadrant pain. Computed tomography showed a wedge in the lower third of the spleen (probably associated with infarction), active bleeding, and hemoperitoneum. Laparotomy and splenectomy were performed. DISCUSSION: The most common symptom of spontaneous splenic rupture is acute abdominal pain, sometimes radiating to the left shoulder. It can also be associated with nausea, emesis and signs of hypovolemia or shock. Splenomegaly may be absent. Diagnostic methods of choice are computed tomography and ultrasound. Management of splenic rupture is divided in surgical and conservative. The former is reserved for patients with extensive splenic injury that is accompanied by hemodynamic instability or other trauma that warrants surgical treatment. Patients who do not meet these criteria and respond to initial stabilization strategies can be offered clinical and laboratory monitoring. Stable patients with moderate to severe splenic injuries can be offered angioembolization. CONCLUSION: It is important to include splenic rupture as a differential diagnosis for acute abdominal pain, especially in patients with hematologic malignancy, since early recognition and treatment increases patient survival and improves prognosis.
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Among osteological anatomic variations are those of the skull base foramina. These openings have conventionally been classified as either constant or variant. Their presence and dimensions have been associated with certain pathologies and procedural complications. Additionally, variability in these foramina between different ethnic groups has been observed, and it is sometimes possible to identify particular patterns of variability in certain populations. This anthropometric cross-sectional study seeks to determine the principal dimensions (bilateral anteroposterior and lateromedial diameters) of five constant skull base foramina in the adult Muisca population of the Tibanica anthropological collection at Universidad de los Andes. The studied foramina were magnum, jugular, ovale, spinosum, and external opening of the carotid canal. Only dimensions of the external openings of the foramina were recorded, owing to the preservation state of the skulls in the collection. The mean left and right anteroposterior and lateromedial diameters were 3.48 mm, 6.16 mm and 3.25 mm, 6.26 mm for the foramen ovale; 2.38 mm, 2.65 mm and 2.39 mm, 2.66 mm for foramen spinosum; 8.36 mm, 15.41 mm and 8.55 mm, 15.10 mm for the jugular foramen; 5.28 mm, 6.75 mm and 5.48 mm, 6.97 mm for the external opening of the carotid canal; and 33.90 mm, 29.47 mm for the foramen magnum. All foramina were measured twice, no important differences were observed between the results obtained in the first and second measurements. The skull base foramina of the sample studied did not suggest high variability within the population regarding these characteristics. Moreover, we can state that the morphometric profile displayed by the Tibanica collection at Universidad de los Andes is different from the one observed in other populations. Additional studies of anatomic variations in indigenous populations may be needed to make possible similarities and/or differences and their causes evident.
Entre las variaciones anatómicas óseas, se consideran aquellas referentes a los forámenes de la base del cráneo. Convencionalmente, estos orificios han sido clasificados como variantes o constantes. Su presencia y dimensiones se asocian a ciertas patologías y complicaciones procedimentales. Adicionalmente, se ha observado variabilidad en estos entre distintos grupos étnicos y en algunas ocasiones es posible identificar patrones particulares en poblaciones específicas. Este estudio morfométrico de corte transversal busca determinar las dimensiones principales (diámetros anteroposterior y lateromedial) de cinco forámenes constantes de la base del cráneo en la población adulta Muisca de la colección antropológica Tibanica de la Universidad de los Andes. Los forámenes estudiados fueron: magno, yugular, ovale, espinoso y la apertura externa del canal carotideo. Debido al estado de preservación de los cráneos, se registraron las dimensiones de las aperturas externas de los forámenes. La media de los diámetros izquierdo y derecho anteroposterior y lateromedial fue 3,48 mm, 6,16 mm y 3,25 mm, 6,26 mm para el foramen ovale; 2,38 mm, 2,65 mm y 2,39 mm, 2,66 mm para el espinoso; 8,36 mm, 15,41 mm y 8,55 mm, 15,10 mm para el yugular; 5,28 mm, 6,75 mm y 5,48 mm, 6,97 mm para la apertura externa del canal carotideo; y 33,90 mm, 29,47 mm para el foramen magno. Todos los diámetros se registraron dos veces, no se observó ninguna diferencia importante entre los registros de la primera y segunda medición. En general, las dimensiones de los forámenes estudiados no varían mucho en la colección ósea Muisca de Tibanica. En cuanto a estas características anatómicas, la población utilizada es diferente con respecto a algunas modernas. Por otro lado, se requieren investigaciones adicionales de este tipo con el fin de evidenciar posibles similitudes y diferencias entre poblaciones (prehispánicas y modernas) y determinar sus causas.
