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]
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. [tmu.pure.elsevier.com]
Entire Body System
- Splenectomy
During recent years, laparoscopic splenectomy has shown to be a safe and effective surgical approach in patients with hematologic disorders requiring spleen removal. [ncbi.nlm.nih.gov]
Two patients underwent emergency splenectomy, 2 patients received delayed splenectomy, and the others were treated conservatively. Time for healing of splenic lesions varied from 1 week to 4 months. [tropicalgastro.com]
- Hodgkin Lymphoma
We report the case of an 80-year-old female patient who underwent laparoscopic splenectomy for symptomatic splenomegaly due to non-hodgkin Lymphoma in combination with stable traumatic splenic hematoma after blunt abdominal trauma. [ncbi.nlm.nih.gov]
[…] v=gip3fDb5O3E Differential Diagnosis -Left kidney trauma/pathology -Rib fracture -Intestinal pathology -Musculoskeletal Involvement -Non-Hodgkin's Lymphoma -Infectious Mononucleosis Case Reports/ Case Studies Spontaneous rupture of the spleen – a fatal [physio-pedia.com]
Immune System
- 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]
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]
However, patients with splenomegaly due to anemia like the one discussed above are more vulnerable to splenic trauma. [e-ultrasonography.org]
- 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]
Gastrointestinal
- 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]
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]
[…] imaging in a patient with unexplained abdominal pain or symptoms of hemodynamic instability after colonoscopy. [aafp.org]
CASE 1 A 54-year-old male presented with acute onset of pain abdominal pain since one day in the left quadrant. He experienced nausea. No fever was reported. [abdominalsurg.org]
- Left Upper Quadrant Pain
Important signs and symptoms that can suggest splenic involvement are increasing pain in the left upper quadrant and pain referred to the left shoulder [1, 9] or findings of a left upper quadrant mass on physical examination. [joplink.net]
Minor hemorrhage often presents as upper left quadrant pain. [en.wikipedia.org]
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]
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]
Liver, Gall & Pancreas
- 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]
Musculoskeletal
- 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]
[…] or left Shoulder Pain Fever Unreliable abdominal examination (e.g. [fpnotebook.com]
in the upper left portion of the stomach (abdomen) or under rib cage Tenderness when you touch the upper left portion of the stomach (abdomen) Left shoulder pain (Kehr’s Sign) Kehr's sign: Pain in the left shoulder caused by irritation of the undersurface [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]
Neurologic
- Irritability
Blood that escapes from within a blood vessel is very irritating to the surrounding tissue and may cause symptoms of inflammation including pain, swelling, and redness. [medicinenet.com]
Blood in the abdomen acts as an irritant and causes pain. The pain is in the left side of the abdomen just below the rib cage. Sometimes the pain is felt in the left shoulder. The abdominal muscles contract reflexively and feel rigid. [merckmanuals.com]
Patients may present with left upper quadrant, left chest pain, left shoulder tip pain (referred from diaphragmatic irritation), and signs of hypotension or shock. [radiopaedia.org]
Pain at the tip of the left shoulder on elevating the legs in the supine position: this is due to the presence of blood leaking from the spleen into the peritoneal cavity, pooling in and thereby irritating the left dome of the diaphragm when the patient [news-medical.net]
Pain may be felt in these locations: Left side of the abdomen under the rib cage Left shoulder, because nerves of the left shoulder and left side of the diaphragm originate from the same location and the rupture may irritate these nerves Internal bleeding [webmd.com]
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]
Serum
- 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]
Laboratory
- Leukocytosis
(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]
However, there was a leukocytosis (16,200/mm 3 ), increased C-reactive protein (18.2 mg/dL), and decreased hemoglobin (11.7 g/dL) and hematocrit (35.9%). [synapse.koreamed.org]
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]
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]
[…] 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]
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]
Epidemiology
Mellouki 2, Dafr Allah Benajeh 2, Meriem Bobo 3, Hicham Bohadouti 4, Siham Tizniti 3, Adil Ibrahimi 2, Khalid Ait Taleb 4, Nabil Kanjaa 1 Publication date (Electronic): 31 July 2015 Journal: The Pan African Medical Journal Publisher: The African Field Epidemiology [scienceopen.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]
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]
After a splenectomy, certain precautions are needed to prevent infections (see Asplenia ). [merckmanuals.com]
Centers for Disease Control and Prevention. https://www.cdc.gov/epstein-barr/about-mono.html. Published September 14, 2016. Accessed April 5, 2017 ↑ Infectious Mononucleosis Differential Diagnoses. [physio-pedia.com]
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]