Five of the cases presented within 24 h of the colonoscopy complaining of severe abdominal pain. Hemodynamic instability was noted in four patients who presented with tachycardia (105-130), hypotension and/or a rapid drop in hemoglobin levels. [ncbi.nlm.nih.gov]

• Sepsis

  […] last only 12-18 hours - Patients complain of fever, nausea, vomiting, headache, and altered mental status Infection may occur at any time after splenectomy [years] Overall mortality rate of 50-80% (This is 78% higher than the usual mortality rate in sepsis [quizlet.com]

  Patients status post splenectomy are at risk for sepsis. Rarely occurs in patients who keep their spleen. Mortality from post-splenectomy sepsis ranges from 38% – 69% S. pneumonia is most common agent. [pedemmorsels.com]

  Postsplenectomy sepsis and mortality in adults. JAMA 1982;248:2279-2283. 44. Holdsworth RJ, Irving AD, Cuschieri A. Postsplenectomy sepsis and its mortality rate: actual versus perceived risks. Br J Surg 1991;78:1031-1038. 45. [ahcmedia.com]

  Abstract Splenectomy for traumatic injury of the spleen has recently been questioned, due to the occurrence of postsplenectomy sepsis. [pediatrics.aappublications.org]

  […] splenectomy should be avoided if possible, particularly in children, the elderly, and patients with hematologic malignancy, to avoid the resulting permanent susceptibility to bacterial infections, increasing the risk of overwhelming postsplenectomy sepsis [merckmanuals.com]

• Asymptomatic

  One patient was asymptomatic, the second developed left upper quadrant pain, and the third required emergency splenectomy. [ncbi.nlm.nih.gov]

  In addition, they tend to be very insidious and asymptomatic in the beginning. The spleen is an organ located in the abdominal cavity under the left costal arch. [health-tutor.com]

  The patient was otherwise asymptomatic, afebrile and did not complain of any abdominal pain. [karger.com]

• Splenomegaly

  Any cause of increased splenocolic adhesions, splenomegaly, or underlying splenic disease might be a predisposing factor for splenic injury during colonoscopy. [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]

  See also [ edit ] Splenomegaly Kehr's sign References [ edit ] ^ Aubrey-Bassler, F.; Sowers, N. (2012). "613 cases of splenic rupture without risk factors or previously diagnosed disease: A systematic review". [en.wikipedia.org]

  Patients typically present within hours to several days after the procedure with abdominal pain and symptoms of hemodynamic instability. 1 Possible predisposing factors include adhesions involving the splenocolic ligaments, splenomegaly, looping at the [aafp.org]

  […] trauma that results in significant intraabdominal bleeding liver injury is the most common cause of bleeding but is more often clinically insignificant Risk factors left-sided rib fractures history of blunt abdominal trauma EBV infection leading to splenomegaly [medbullets.com]

• Left Upper Quadrant Pain

  One patient was asymptomatic, the second developed left upper quadrant pain, and the third required emergency splenectomy. [ncbi.nlm.nih.gov]

  Lesser hemorrhage causes left upper quadrant abdominal pain, which sometimes radiates to the left shoulder. [merckmanuals.com]

  He complains of extreme abdominal pain worse in the left upper quadrant which has worsened over the past 30 minutes. Exam demonstrates abdominal wall rigidity, involuntary guarding, and tenderness on light percussion. [medbullets.com]

• Abdominal Distension

  Right quadrant/left abdominal pain Left shoulder pain Severe or mild pain Rebound tenderness Muscle guarding Nausea Profuse sweating or hot and cold sensations Abdominal distension or ecchymosis (bruising) Light headedness or syncope (fainting) Fatigue [ksi.uconn.edu]

  With increasing blood loss into the abdominal cavity, abdominal distension, peritoneal signs, and overt shock may be observed. [emedicine.medscape.com]

• Severe Abdominal Pain

  Five of the cases presented within 24 h of the colonoscopy complaining of severe abdominal pain. Hemodynamic instability was noted in four patients who presented with tachycardia (105-130), hypotension and/or a rapid drop in hemoglobin levels. [ncbi.nlm.nih.gov]

• Jaundice

  Case Report A 59-year-old woman presented to the hospital with progressive right upper quadrant abdominal pain for 7 days accompanied by profound jaundice. [karger.com]

• Hypotension

  One of these patients presented with hypotension on day 5 after discharge from the hospital. Both patients needed emergency laparotomy, and one of them required splenectomy for management of the injury. [ncbi.nlm.nih.gov]

• Fracture

  The incidence of splenic injury among patients sustaining 5 or more rib fractures was significantly higher compared to patients suffering from 1 to 4 rib fractures. [ncbi.nlm.nih.gov]

  […] laceration have rib fractures Subcapsular hematoma Crescentic low-attenuation area Usually along lateral margin Flattens normal convex margin of spleen Parenchymal lesion Indistinct splenic margin Inhomogeneous enhancement Fractured spleen Complete separation [learningradiology.com]

  Maintain a high index of suspicion for splenic injury in patients who have left rib fractures. [merckmanuals.com]

• Withdrawn

  As the side-viewing duodenoscope is usually advanced into a loop (long) position in order to reach the second part of the duodenum, the scope has to be torqued to the right and withdrawn partially (short position) to bring the ampulla into a satisfactory [karger.com]

Workup included a testicular ultrasound scan with colorflow Doppler as well as abdominal and pelvic computerized tomography. [ncbi.nlm.nih.gov]

[…] traumatic pseudoaneurysm, moderate hemoperitoneum, evidence of ongoing splenic bleeding requiring blood transfusion, arteriovenous fistula, and evidence of active extravasation suggested by contrast blush on CT. 4,5,6,7,8,9 All blunt trauma patients undergo workup [uktraumaprotocol.blogspot.com]

If the patient has a normal pulse rate and blood pressure, then workup can proceed to CT scanning with IV contrast to determine whether a “blush” of “extravasated contrast” is present. [jlgh.org]

Symptoms primarily (74%) appeared within 24 hours, and workup in the form of blood tests and CT scanning was performed in the majority (93.9%). [3] In addition, over half of (56.1%) affected patients underwent laparotomy and splenectomy, with the most [emedicine.medscape.com]

[…] that repeat examinations be performed; a significant number of patients with hemoperitoneum are noted to have had "normal" initial abdominal findings. 12 If the initial physical exam is normal, yet the suspicion is high for an abdominal injury, further workup [ahcmedia.com]

• Streptococcus Pneumoniae

  The most common pathogen is Streptococcus pneumoniae, but other encapsulated bacteria such as Neisseria and Haemophilus species may also be involved. [merckmanuals.com]

  After removal of the spleen, these functions are lost and the patient could be susceptible to an overwhelming post-splenectomy infections from bacteria such as streptococcus pneumoniae, neisseria meningitidis, and hemophilus influenza. [aast.org]

  This involves documentation (alert identification) of the asplenic state, vaccination for encapsulated organisms ( Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae ); antibiotic prophylaxis availability; and documentation to [ahcmedia.com]

In the embolization group, 1 (7%) of 15 failed initial treatment and underwent splenectomy. [ncbi.nlm.nih.gov]

Moreover, the hypothesis that incidental splenectomy carries a worse prognosis deserves attention. [ncbi.nlm.nih.gov]

[…] 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]

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

[…] quadrant pain Evaluation Imaging CT scan important in showing extent of splenic injury Exploratory laparotomy Treatment Surgical endovascular embolization indicated with incomplete rupture splenectomy indicated with complete rupture or intractable bleeding Prognosis [medbullets.com]

Although currently lacking comparative and larger studies, preventive spleen embolization seems to have potential in high-grade trauma and/or in patients who have high-risk prognosis factors (eg, age > 50 years, polytraumatism, intraperitoneal bleeding [evtoday.com]

Back Home Splenic Trauma (Penetrating) Background Definition Injury to the spleen due to penetrating trauma Etiology Gunshot wounds Stab wounds Other implements A delayed threat to life Pathophysiology Spleen receives 5% of cardiac output Mostly through [fprmed.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]

Etiology Splenic injury is most often observed in blunt trauma. While penetrating trauma (eg, gun shot wounds, knife wounds) may involve the spleen, the incidence of injury is well below that of the small and large intestine. [emedicine.medscape.com]

The epidemiology and validation of the spleen injury CPG were analyzed. METHODS: The Joint Theater Trauma Registry was queried for splenic injury from 2001 to 2010. [ncbi.nlm.nih.gov]

Back Home Splenic Trauma (Penetrating) Background Definition Injury to the spleen due to penetrating trauma Etiology Gunshot wounds Stab wounds Other implements A delayed threat to life Pathophysiology Spleen receives 5% of cardiac output Mostly through [fprmed.com]

[…] 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]

Pathophysiology Though normally protected by its anatomic position, preexisting illness or disease can markedly increase the risks and severity of splenic injury. [emedicine.medscape.com]

[…] by the pediatric experience with successful non-operative management (NOM), an understanding of the intact spleen’s vital role in healthy immune function, and the use of more detailed diagnostic modalities to further delineate the extent of injury. 2 PATHOPHYSIOLOGY [jlgh.org]

Significant resources, including angiography (ANGIO), are used in an effort to prevent delayed splenectomy (DS). No prospective, long-term data exist to determine the actual risk of splenectomy. [ncbi.nlm.nih.gov]

CURATIVE AND PREVENTIVE EMBOLIZATION The embolization indication is called curative when parenchymal bleeding has to be fixed ( Figure 3 ). [evtoday.com]