RESUMO
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.
Assuntos
Fraturas Ósseas , Ruptura Esplênica , Tromboembolia Venosa , Humanos , Heparina de Baixo Peso Molecular/uso terapêutico , Tromboembolia Venosa/etiologia , Tromboembolia Venosa/prevenção & controle , Aspirina/uso terapêutico , Perda Sanguínea Cirúrgica , Estudos Retrospectivos , Fraturas Ósseas/cirurgia , Anticoagulantes/uso terapêutico , Ruptura Esplênica/induzido quimicamente , Ruptura Esplênica/complicações , Ruptura Esplênica/tratamento farmacológico , Hematoma , Extremidade Inferior/cirurgia , Heparina/efeitos adversosRESUMO
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.
Assuntos
Amiloidose de Cadeia Leve de Imunoglobulina/patologia , Hepatopatias/patologia , Ruptura Esplênica/patologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina/complicações , Amiloidose de Cadeia Leve de Imunoglobulina/tratamento farmacológico , Hepatopatias/complicações , Hepatopatias/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Prognóstico , Ruptura Esplênica/complicações , Ruptura Esplênica/tratamento farmacológicoRESUMO
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.
Assuntos
Antiparasitários/uso terapêutico , Babesiose/complicações , Clindamicina/uso terapêutico , Quinina/uso terapêutico , Ruptura Esplênica/parasitologia , Babesiose/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Ruptura Esplênica/tratamento farmacológico , Resultado do TratamentoRESUMO
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.
Assuntos
Antineoplásicos/uso terapêutico , Bortezomib/uso terapêutico , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Amiloidose de Cadeia Leve de Imunoglobulina/complicações , Amiloidose de Cadeia Leve de Imunoglobulina/tratamento farmacológico , Mieloma Múltiplo/complicações , Ruptura Esplênica/tratamento farmacológico , Transplante Autólogo/efeitos adversos , Fator Estimulador de Colônias de Granulócitos , Hematopoese Extramedular , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/terapia , Ruptura Esplênica/etiologiaRESUMO
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.
Assuntos
Paraproteinemias/complicações , Transplante de Células-Tronco de Sangue Periférico/efeitos adversos , Ruptura Espontânea/etiologia , Ruptura Esplênica/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Ruptura Espontânea/tratamento farmacológico , Ruptura Esplênica/tratamento farmacológico , Transplante Autólogo/efeitos adversos , Resultado do TratamentoRESUMO
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.
Assuntos
Abscesso Abdominal/microbiologia , Peritonite/microbiologia , Ruptura Esplênica/microbiologia , Febre Tifoide/complicações , Abscesso Abdominal/diagnóstico por imagem , Abscesso Abdominal/tratamento farmacológico , Abscesso Abdominal/cirurgia , Adulto , Antibacterianos/uso terapêutico , Humanos , Masculino , Peritonite/diagnóstico por imagem , Peritonite/tratamento farmacológico , Peritonite/cirurgia , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/tratamento farmacológico , Ruptura Esplênica/cirurgia , Tomografia Computadorizada por Raios X , Febre Tifoide/diagnóstico por imagem , Febre Tifoide/tratamento farmacológico , UltrassonografiaRESUMO
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.
Assuntos
Ruptura Esplênica/diagnóstico , Ruptura Esplênica/terapia , Dor Abdominal/etiologia , Evolução Fatal , Hemoperitônio/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Raras , Ruptura Espontânea , Esplenectomia , Ruptura Esplênica/tratamento farmacológico , Ruptura Esplênica/cirurgia , Resultado do TratamentoAssuntos
Fator Estimulador de Colônias de Granulócitos/efeitos adversos , Mieloma Múltiplo/terapia , Transplante de Células-Tronco de Sangue Periférico , Ruptura Esplênica/complicações , Ruptura Esplênica/tratamento farmacológico , Adulto , Feminino , Filgrastim , Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Humanos , Polietilenoglicóis , Proteínas Recombinantes , Fatores de Risco , Ruptura Espontânea , Ruptura Esplênica/diagnóstico , Transplante Autólogo , Resultado do TratamentoAssuntos
Leishmania donovani/isolamento & purificação , Leishmaniose Visceral/complicações , Ruptura Esplênica/microbiologia , Idoso , Animais , Antiprotozoários/uso terapêutico , Humanos , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/tratamento farmacológico , Masculino , Meglumina/uso terapêutico , Antimoniato de Meglumina , Compostos Organometálicos/uso terapêutico , Radiografia , Ruptura Espontânea , Baço/diagnóstico por imagem , Baço/microbiologia , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/tratamento farmacológico , Resultado do TratamentoRESUMO
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.
Assuntos
Anticoagulantes/efeitos adversos , Fibrinolíticos/efeitos adversos , Hemoperitônio/induzido quimicamente , Heparina de Baixo Peso Molecular/efeitos adversos , Ruptura Esplênica/induzido quimicamente , Idoso , Anticoagulantes/administração & dosagem , Carcinoma de Células Pequenas/tratamento farmacológico , Carcinoma de Células Pequenas/patologia , Feminino , Fibrinolíticos/administração & dosagem , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/tratamento farmacológico , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/patologia , Embolia Pulmonar/tratamento farmacológico , Radiografia , Ruptura Espontânea , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/tratamento farmacológico , Fatores de Tempo , Tinzaparina , Resultado do Tratamento , Trombose Venosa/tratamento farmacológicoRESUMO
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.
Assuntos
Granulomatose com Poliangiite/diagnóstico , Ruptura Esplênica/diagnóstico , Administração Oral , Idoso , Ciclofosfamida/uso terapêutico , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/tratamento farmacológico , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/uso terapêutico , Masculino , Prednisona/uso terapêutico , Ruptura Esplênica/tratamento farmacológico , Ruptura Esplênica/etiologia , Resultado do TratamentoAssuntos
Leucemia Linfocítica Crônica de Células B/complicações , Ruptura Esplênica/etiologia , Dor Abdominal/etiologia , Antineoplásicos/administração & dosagem , Humanos , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Leucemia Linfocítica Crônica de Células B/patologia , Masculino , Pessoa de Meia-Idade , Ruptura Esplênica/diagnóstico por imagem , Ruptura Esplênica/tratamento farmacológico , Tomografia Computadorizada por Raios XRESUMO
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.
Assuntos
Hematoma/cirurgia , Hemofilia A/cirurgia , Ruptura Esplênica/cirurgia , Traumatismos Abdominais/complicações , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/cirurgia , Adolescente , Perda Sanguínea Cirúrgica/prevenção & controle , Fator VIII/administração & dosagem , Hematoma/diagnóstico por imagem , Hematoma/etiologia , Hemofilia A/complicações , Hemofilia A/tratamento farmacológico , Humanos , Masculino , Radiografia , Esplenectomia , Ruptura Esplênica/tratamento farmacológico , Ruptura Esplênica/etiologiaAssuntos
Abscesso/microbiologia , Infecções por Bacteroides/microbiologia , Bacteroides fragilis/isolamento & purificação , Peritonite/microbiologia , Ruptura Esplênica/microbiologia , Abscesso/tratamento farmacológico , Abscesso/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Infecções por Bacteroides/tratamento farmacológico , Infecções por Bacteroides/fisiopatologia , Feminino , Humanos , Peritonite/tratamento farmacológico , Peritonite/fisiopatologia , Ruptura Esplênica/tratamento farmacológico , Ruptura Esplênica/fisiopatologia , Tomografia Computadorizada por Raios XRESUMO
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.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Hemangiossarcoma/tratamento farmacológico , Neoplasias Esplênicas/tratamento farmacológico , Ruptura Esplênica/tratamento farmacológico , Terapia Combinada , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Feminino , Hemangiossarcoma/complicações , Hemangiossarcoma/patologia , Hemangiossarcoma/cirurgia , Humanos , Pessoa de Meia-Idade , Metástase Neoplásica , Cuidados Pós-Operatórios , Prednisona/administração & dosagem , Ruptura Espontânea , Esplenectomia , Neoplasias Esplênicas/complicações , Neoplasias Esplênicas/patologia , Neoplasias Esplênicas/cirurgia , Ruptura Esplênica/etiologia , Ruptura Esplênica/patologia , Ruptura Esplênica/cirurgia , Vincristina/administração & dosagemRESUMO
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
Assuntos
Baço , Ruptura Esplênica/tratamento farmacológico , Ruptura Esplênica/cirurgia , Ferimentos e LesõesRESUMO
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.