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Splenic Hematoma

Splenic Haematoma


Presentation

  • The present study report a two day old infant who presented to us in shok with severe pallor and abdominal distension.[ncbi.nlm.nih.gov]
  • @inbook{dfb1cccb290a4e0fab4164f2ec127e32, title "Calcified splenic hematoma presenting as a pelvic mass.[tmu.pure.elsevier.com]
Hemophilia A
  • Involvement of the spleen in hemophilia is rare, at all ages. Also uncommon are hemorrhagic manifestations of hemophilia during the neonatal period. Calcified splenic hematomas in hemophilic patients have apparently never been described.[ncbi.nlm.nih.gov]
  • Individuals with the following conditions are potentially at a higher risk for hematomas: chronic (long standing) liver disease, excessive alcohol use, bleeding disorders (such as hemophilia and Von Willebrand disease), blood cancers, or low platelet[rxlist.com]
Intravenous Drugs
  • We present a patient with a known history of intravenous drug abuse and recent abdominal trauma who was found to have infective endocarditis and subsequently an infected splenic hematoma. The related literature is also discussed.[ncbi.nlm.nih.gov]
Localized Pain
  • Local pain was encountered in 12 (26.6%) and lasted for a mean ( /- SD) of 7 /- 3.8 hours. Local tenderness was noted in 17 (37.7%) and lasted for 6.8 /- 3.7 hours.[ncbi.nlm.nih.gov]
Splenomegaly
  • Especially in cases with splenomegaly, the laparoscopic approach results in a shorter hospital stay and faster recovery of the patients.[ncbi.nlm.nih.gov]
  • However, patients with splenomegaly due to anemia like the one discussed above are more vulnerable to splenic trauma.[e-ultrasonography.org]
  • Hypersplenism (Medical Encyclopedia) Spleen removal (Medical Encyclopedia) Spleen removal - laparoscopic - adults - discharge (Medical Encyclopedia) Spleen removal - open - adults - discharge (Medical Encyclopedia) Splenomegaly (Medical Encyclopedia)[icdlist.com]
Massive Splenomegaly
  • In the past decade, laparoscopy has become the standard approach for elective splenectomy, even for patients such as ours, presenting with massive splenomegaly and hematoma [9].[ncbi.nlm.nih.gov]
Massive Splenomegaly
  • In the past decade, laparoscopy has become the standard approach for elective splenectomy, even for patients such as ours, presenting with massive splenomegaly and hematoma [9].[ncbi.nlm.nih.gov]
Chest Wall Pain
  • The patient was subsequently rechallenged with filgrastim, which led to recurrence of the left-sided chest-wall pain. Filgrastim was discontinued and the patient reported resolution of the pain.[ncbi.nlm.nih.gov]
Abdominal Pain
  • Importance of considering splenic hematoma and/or rupture if abdominal pain occurs in the course of mononucleosis syndrome is outlined as well as importance of routine laboratory tests in suspecting mononucleosis syndrome in otherwise clinically silent[ncbi.nlm.nih.gov]
  • We report a 59 years old male who presented an acute abdominal pain and dyspnea while staying at high altitude. Six days later, an angio CAT scan showed the presence of a subcapsular splenic hematoma that was managed conservatively.[revistamedicadechile.cl]
  • Am Fam Physician. 2011 Apr 1;83(7):786-792. to the editor : A 56-year-old woman presented to the emergency department with left-sided pleuritic chest pain and upper abdominal pain that began the previous day after a reportedly uneventful diagnostic colonoscopy[aafp.org]
  • Case Report A 35 years male was admitted with abdominal pain, tachycardia, hypotension, pallor and anaemia (Hb – 5.0 gm/ dl). Physical examination revealed fullness and tenderness in the left hypochondrium.[tropicalgastro.com]
  • This situation is practically asymptomatic or it causes a mild abdominal pain located in the left upper quadrant. The bleeding may stop, but if it continues, the hematoma enlarges and the capsule may suddenly rupture as well.[health-tutor.com]
Left Upper Quadrant Pain
  • Patients with pancreatitis presenting with a mass in the left upper quadrant, pain radiating to the left shoulder, and a fall in haemoglobin should be suspected to have a hemorrhagic complication and urgently admitted.[tropicalgastro.com]
  • She was admitted with epigastric and left upper quadrant pain of two days duration. She had an attack of mild acute pancreatitis of unknown aetiology three months previously.[joplink.net]
  • Patients with unexplained left upper quadrant pain, particularly if there is evidence of hypovolemia or shock, are generally inquired regarding any recent trauma. [1] The primary concern in any splenic trauma is internal hemorrhage, though the exact amount[en.wikipedia.org]
  • Case Report A 14-year-old boy presented to the Emergency Department of our hospital complaining of left upper quadrant pain after an accident during which he fell onto his bicycle’s handlebars.[e-ultrasonography.org]
Acute Abdomen
  • Fevzi Cengiz, Savaş Yakan, İlhan Enver Clinic of 1st General Surgery, İzmir Bozyaka Training Hospital, İzmir, Turkey Abstract Splenic subcapsular hematoma and splenic rupture due to pancreatitis is a rare cause of acute abdomen.[turkjsurg.com]
  • INTRODUCTION A rupture of the spleen is one of many causes of the acute abdomen and in most cases of traumatic origin.[abdominalsurg.org]
Pelvic Mass
  • @inbook{dfb1cccb290a4e0fab4164f2ec127e32, title "Calcified splenic hematoma presenting as a pelvic mass.[tmu.pure.elsevier.com]
  • Herein, we report on a senile female with blunt abdominal trauma 6 years previous, who turned out to have a calcified splenic hematoma with clinical presentations of a palpable pelvic mass and intestinal obstruction.[ncbi.nlm.nih.gov]
Left Flank Pain
  • We report here on a case of pseudocyst with a large subcapsular splenic hematoma in a 43-year-old man who presented with severe left flank pain for one week.[ncbi.nlm.nih.gov]
  • However, on the sixth day, the patient complained of a sudden onset of severe left flank pain not relieved by analgesics, and the hemoglobin levels were decreased (9.7 g/dL). However, there was no hypotension.[synapse.koreamed.org]
Jaundice
  • We report a five-days-old female infant with neonatal jaundice secondary to splenic hematoma.[ncbi.nlm.nih.gov]
  • Six months after surgery he reported with jaundice, elevated liver enzymes, elevated serum amylase and pain in the epigastric region. These findings were most likely due to pancreatitis.[abdominalsurg.org]
Neonatal Jaundice
  • We report a five-days-old female infant with neonatal jaundice secondary to splenic hematoma.[ncbi.nlm.nih.gov]
Left Shoulder Pain
  • […] pt complaining of left shoulder pain after abdominal trauma pt with noted rib fractures (it takes a lot of force to fracture those compliant pediatric ribs) pt with multi-trauma Unfortunately, a contained rupture may have few initial symptoms.[pedemmorsels.com]
  • Shoulder Pain Fever Unreliable abdominal examination (e.g.[fpnotebook.com]
  • shoulder pain (Kehr’s Sign) Kehr's sign: Pain in the left shoulder caused by irritation of the undersurface of the diaphragm by blood leaking from a ruptured spleen.[physio-pedia.com]
  • Scroll through the images and describe the findings On the left images of a 22-year old male who presented 3 hours after a snowboarding accident with LUQ and left shoulder pain. Scroll through the images and describe the lesions. Then continue.[radiologyassistant.nl]
Kidney Failure
  • This may be an option for stable patients with kidney failure or who have severe allergies to the contrast substance used during a CT scan.[webmd.com]
Intracranial Hemorrhage
  • A 7-day-old hemophilic newborn presented several hemorrhagic manifestations, notably a large cephalohematoma, intracranial hemorrhage and a splenic hematoma.[ncbi.nlm.nih.gov]

Workup

  • Preoperative laboratory workup including Complete Blood Count, parasitic serologies and chemistries were within normal limits. Pneumovax 23 23-valent pneumococcal polysaccharide vaccine was administered 2 weeks prior to the planned splenectomy.[ncbi.nlm.nih.gov]
  • Left lower rib fracture is present in 44% of patients with splenic rupture and necessitates further workup by abdominal CT.[emedicine.medscape.com]
Thrombocytosis
  • (see differential diagnoses below) References: [3] Diagnostics Laboratory tests : low Hb, leukocytosis, and thrombocytosis ; crossmatch for blood transfusion if needed In hemodynamically unstable patients First ultrasound : focused assessment with sonography[amboss.com]

Treatment

  • Despite the initial conservative treatment consisting of pain control, bowel rest, intravenous fluids and antibiotics, the pain was not relieved.[ncbi.nlm.nih.gov]
  • The follow-up and treatment of splenic complications should not be similar to the follow-up and treatment of traumatic subcapsular hematoma, follow up criteria must be defined and keeping the next probable pancreatitis attack in mind radical treatment[turkjsurg.com]
  • treatment option for the subcapsular splenic hematoma complicating a pancreatic pseudocyst in a patient with multiple episodes of pancreatitis.[synapse.koreamed.org]

Prognosis

  • Abstract A male Japanese Tosa Dog 7years old with large spleen hematoma was rescued successfully from bad prognosis by surgical removal. Before clinical observation and surgery, this case was diagnosed as sever canine filariasis.[jstage.jst.go.jp]
  • […] lobulation of the spleen after development in contrast to a laceration, a cleft is usually smooth with a rounded edge and are not associated with an adjacent subcapsular hematoma or perisplenic fluid some larger clefts may contain fat Treatment and prognosis[radiopaedia.org]
  • Splenic infarct • Splenic cyst • Lymphoma and splenic tumors CLINICAL ISSUES • Most commonly injured solid abdominal organ in blunt trauma and most common abdominal organ injury requiring surgery • Prone to develop delayed hemorrhage, but excellent prognosis[clinicalgate.com]
  • Prognosis The ample blood supply to the spleen can promote rapid healing. Studies have shown that intra-abdominal bleeding associated with splenic trauma stops without surgical intervention in up to two out of three cases in children.[medical-dictionary.thefreedictionary.com]
  • The location of a hematoma plays a role in its prognosis. From Reviewed by: Tova Alladice, M.D. American Board of Physical Medicine & Rehabilitation[rxlist.com]

Etiology

  • In the absence of local factors, the etiology of splenic hemorrhage remains unknown.[ncbi.nlm.nih.gov]
  • As is seen in our case, the risk of splenic rupture should not be ignored before elimination of the etiology.[turkjsurg.com]
  • Anatomy and etiology The spleen is a functionally complex organ occupying the left upper quadrant (LUQ). It is an intraperitoneal organ weighing 75-100 g in the adult.[emedicine.medscape.com]
  • Etiology Blunt abdominal trauma Most frequently caused by m otor vehicle accidents leading to liver and spleen injury Also caused by falls from high heights ;, domestic violence, and sport-related trauma Other causes Left-sided thoracic trauma with fractures[amboss.com]
  • Laceration of greater than 3 cm in depth or involving trabecular vessels. [15] Grade V - Shattered spleen or hilar vascular injury [15] Etiology/Causes Traumatic (common) [3] • Injury or blow to left side of the body (left upper abdomen or left lower[physio-pedia.com]

Pathophysiology

  • […] splenic salvage maneuver Grade IV Fragmented spleen with major devascularization Surgical intervention: splenectomy, a partial splenic resection if possible Grade V Hilar laceration/shattered spleen Surgical intervention: splenectomy References: [2] Pathophysiology[amboss.com]

Prevention

  • Abstract The use of a nasogastric tube to empty the stomach contents prevents compression of the splenic parenchyma and allows clear visualization of the anterior medial border of the spleen and perisplenic area.[ncbi.nlm.nih.gov]
  • A more aggressive approach, early splenectomy, has also been advocated for the treatment of splenic hematoma in order to prevent blood loss and potential splenic rupture [1, 8, 10].[turkjsurg.com]
  • They suggested that treatment of splenic hematoma should be splenectomy in majority of patients to prevent continuing blood loss and potential rupture.[ 5 ] Percutaneous drainage for splenic subcapsular collections may be a feasible treatment, but there[tropicalgastro.com]
  • Can a hematoma be prevented? Prevention of all hematomas is not entirely possible. However, prevention of hematomas in certain contexts deserves special attention.[rxlist.com]
  • Grade 3 spleen prevention-mesh splenorrhaphy. Available: (assessed 30 Mar 2012) 21.0 21.1 Shultz SJ, Houglum PA, Perrin DH. Examination of Musculoskeletal Injuries, 2nd ed. Champaign, IL, 2005. p. 570-571[physio-pedia.com]

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