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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]
  • We describe the presentation and the clinical progress of a case in whom a sudden enlargement in hematoma's diameter needed a splenectomy to avoid the risk of blood effusion in the abdominal cavity.[ncbi.nlm.nih.gov]
  • 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]
  • Particular care should be taken when a patient presents with a cystic mass in the region of the spleen and a history of chronic alcohol abuse, regardless of the presence or absence of a history of a traumatic episode.[ncbi.nlm.nih.gov]
  • A 7-day-old hemophilic newborn presented several hemorrhagic manifestations, notably a large cephalohematoma, intracranial hemorrhage and a splenic hematoma.[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]
  • Although filgrastim-induced splenomegaly, splenic hematomas, and splenic rupture are rare, clinicians working in the bone marrow transplant setting should be cognizant of the potential of growth factors to cause these adverse events.[ncbi.nlm.nih.gov]
  • Approach to the patient with lymphadenopathy and splenomegaly. In: Goldman-Cecil Medicine. 25th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. . Accessed Feb. 5, 2016. Marx JA, et al., eds. Abdominal trauma.[mayoclinic.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]
  • D73.3 Abscess of spleen D73.5 Infarction of spleen D73.8 Other diseases of spleen D73.81 Neutropenic splenomegaly D73.89 Other diseases of spleen D73.9 Disease of spleen, unspecified D74 Methemoglobinemia D74.0 Congenital methemoglobinemia D74.8 Other[icd10data.com]
Massive Splenomegaly
  • Splenectomy for massive splenomegaly: Long-term results and risks for mortality. Annals of Surgery. 2013;258:1034. Bartlett A, et al. Splenic rupture in infectious mononucleosis: A systematic review of published case reports. Injury. In press.[mayoclinic.org]
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
  • 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]
  • 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]
  • 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]
  • Because the patient in this case was hemodynamically stable, had no signs of infection, refused surgical treatment due to the fear of complications, US-guided percutaneous drainage was performed to alleviate the abdominal pain and decompress the expanding[synapse.koreamed.org]
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] Diagnosis [ edit ] Diagnosis is confirmed with CT , or bedside ultrasound for less[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]
Neonatal Jaundice
  • We report a five-days-old female infant with neonatal jaundice secondary to splenic hematoma.[ncbi.nlm.nih.gov]
Left Shoulder Pain
  • Symptoms Signs and symptoms of a ruptured spleen include: Pain in the upper left abdomen Tenderness when you touch the upper left abdomen Left shoulder pain, particularly if you also have cuts and bruises on the left chest or side Confusion, lightheadedness[mayoclinic.org]
  • […] 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]

Workup

  • 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

  • Radical treatment comprised exercsis of the cystic structure, splenectomy and caudal pancreatectomy.[ncbi.nlm.nih.gov]
  • The patient was referred to another hospital for conservative treatment in the outpatient clinic.[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]
  • 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]

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]
  • Radiology 162: 69–71 PubMed Google Scholar Mirvis SE, Whitley NO, Gens DR (1989) Blunt splenic trauma in adults: CT-based classification and correlation with prognosis and treatment. Radiology 171: 33–39 PubMed Google Scholar Shanmuganathan K.[link.springer.com]
  • […] 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 haematoma 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]

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[amboss.com]
  • Laceration of greater than 3 cm in depth or involving trabecular vessels. [17] Grade V - Shattered spleen or hilar vascular injury [17] Etiology/Causes Traumatic (common) [5] • Injury or blow to left side of the body (left upper abdomen or left lower[physio-pedia.com]

Epidemiology

  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.com]
Sex distribution
Age distribution

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

  • 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) 23.0 23.1 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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