Dear Editor, A 23-year-old male patient presented with a 36-h history of intense, sudden, progressive abdominal pain, predominantly in the left hypochondrium, irradiating to the ipsilateral infrascapular region. [ncbi.nlm.nih.gov]

Case Report Case presentation A 65-year-old Caucasian female with a history of colon polyps presented to her gastroenterologist for routine screening colonoscopy. Usual colonic preparations were followed. [tgh.amegroups.com]

Case report A 41-year-old man presented at the emergency department with complaints of intolerable pain in the left upper quadrant. [jbsr.be]

• Fever

  He reported no previous trauma, fever, headache, fatigue, myalgia, arthralgia, skin alterations, or comorbidities. [semanticscholar.org]

  Only rarely ruptures spontaneously (associated with acute splenitis, amyloidosis [rare], infectious mononucleosis, inflammatory disorders, leukemia / lymphoma, malaria, other tumors, peliosis lienis, pregnancy, subacute bacterial endocarditis, typhoid fever [pathologyoutlines.com]

  Significant past history was that of typhoid fever 1 month back, for which he had taken treatment for 2 weeks and got cured. On examination, the patient appeared anemic and lethargic. [atmph.org]

• Splenomegaly

  Splenomegaly is defined as cranio-caudal length greater than 13 cm by ultrasound [ 7 ]. [omicsonline.org]

  Diseases Causing Splenomegaly Separated Into 3 Categories Mild Splenomegaly (Organ Weight Moderate Splenomegaly (Organ Weight 500–800 g) Severe Splenomegaly (Organ Weight >800 g) Bacterial infection Portal hypertension Chronic myeloproliferative diseases [onlinelibrary.wiley.com]

  Abdominal examination revealed tender palpable splenomegaly, without guarding. [em-consulte.com]

  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

  Splenomegaly is most commonly asymptomatic in Sarcoidosis but when massive (3% of patients) it also can be a cause of massive splenic infarction [ 17 ]. [omicsonline.org]

  Fordice J, Katras T, Jackson RE, et al: Massive splenomegaly in sarcoidosis. South Med J 1992;85:775–778. Webb AK, Mitchell DN, Bradstreet CM, et al: Splenomegaly and splenectomy in sarcoidosis. J Clin Pathol 1979;32:1050–1053. [karger.com]

• Abdominal Pain

  Three days later, he was admitted because of persistent abdominal pain [jamanetwork.com]

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

  Two days later he started to complain of acute abdominal pain, and laboratory findings showed a low hemoglobin level. [read.qxmd.com]

  A 23-year-old male patient presented with a 36-h history of intense, sudden, progressive abdominal pain, predominantly in the left hypochondrium, irradiating to the ipsilateral infrascapular region. [semanticscholar.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. [pancreas.imedpub.com]

  Case of the Week: November 14-November 21, 2013 13 year old with ground level fall with left upper quadrant pain (Click for a larger image.) [pedsradiology.com]

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

  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]

• Left Flank Pain

  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]

• Left Shoulder Pain

  Patient may complain of left shoulder pain Physical exam Note: Negative exam does not preclude injury Unreliable Perform serial exams External inspection Count number of entrance/exit wounds Odd number may indicate retained bullet LUQ injury: high likelihood [fprmed.com]

  […] 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]

  However, suddenly after defecation (72 h after the injury), he started complaining of severe abdominal pain and left shoulder pain. His blood pressure dropped to 70/35 mmHg, and he started to lose consciousness. [surgicalcasereports.springeropen.com]

  […] or left Shoulder Pain Fever Unreliable abdominal examination (e.g. [fpnotebook.com]

• Withdrawn

  To prevent hemorrhage after fine‐needle biopsy, fibrin glue can be injected into the puncture canal as the puncture needle is withdrawn. Fibrin glue in the puncture canal is imaged as a hyperechoic canal (arrow). [onlinelibrary.wiley.com]

On day-10, blood workup and ultrasound were unremarkable. Drains removed and antibiotics were discontinued. He remained for wound infection care. On day-18, he had fever and subcostal pain. [ijcasereportsandimages.com]

Workup • Hematological investigations • Radiological investigations 28. [slideshare.net]

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]

  Although very little good data exist, many surgeons treat persistent thrombocytosis with a daily baby aspirin. [emedicine.medscape.com]

• Hemoglobin Decreased

  […] every 6 hours for the first 24 hours Nothing by mouth for the first 24 hours May then eat when emergent surgery is unlikely Must first demonstrate stable Vital Sign s and serial Hemoglobin s Consider repeat Abdominal CT imaging Hemoglobin decrease (via [fpnotebook.com]

• Enlargement of the Spleen

  Enlargement of the spleen (for example, due to Epstein-Barr virus causing infectious mononucleosis ) makes the spleen more susceptible to injury. When the spleen is injured, blood may be released into the abdomen. [merckmanuals.com]

  On the second day, US demonstrated an enlarged spleen with a longitudinal diameter of 17.7 cm and a rounded accessory spleen with a diameter of 1.4 cm situated near the splenic hilum. [e-ultrasonography.org]

  […] ruptures, and hemangiomas as well as accessory spleens. 7 Pathologic Conditions of the Spleen Splenomegaly Splenomegaly is the acute or chronic enlargement of the spleen, defined as a weight of greater than 250 g and a sonographic width of greater than [onlinelibrary.wiley.com]

  Table 1(part1) click to enlarge Table 1(part1) click to enlarge Table 2 click to enlarge When examining a non-trauma patient with abdominal pain in the left upper quadrant a doctor has to bear the diagnosis of a non-traumatic rupture of the spleen in [abdominalsurg.org]

  Intraparenchymal hematoma is a broader, more irregular, hypoattenuating area with mass effect and enlargement of the spleen. [emedicine.medscape.com]

Discussion Medical imaging plays an important role in the treatment selection for renal stones [ 1, 2 ]. [jbsr.be]

treatment option for the subcapsular splenic hematoma complicating a pancreatic pseudocyst in a patient with multiple episodes of pancreatitis. [synapse.koreamed.org]

Follow clinically Arterial embolization/coiling Splenorrhaphy Splenectomy Treatment options The higher the grade the more likely the need for an intervention Grade I and II are usually followed clinically unless they worsen Grade IV and V usually require [learningradiology.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]

Our renowned surgeons and faculty continue to push the frontiers of surgical science through innovative treatment and leading-edge research, changing lives and the future of surgical treatment, each and every day. [medicine.yale.edu]

The AAST grading system is not a predictor of prognosis or outcome in children. [pedsradiology.com]

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]

Splenic angiosarcoma behaves extremely aggressive and has poor prognosis. Case Presentation. [read.qxmd.com]

In view of the diverse patient population, patient selection for a specific intervention modality is very important to improve prognosis. [atmph.org]

In such a case, an appropriate assessment of the etiology can support early detection followed by early resection of pancreatic cancer. [jstage.jst.go.jp]

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]

As is seen in our case, the risk of splenic rupture should not be ignored before elimination of the etiology. [turkjsurg.com]

Splenic Rupture The recognized categories of etiologies of non-traumatic splenic rupture [ 1, 3 ] ( Table 2 ). [omicsonline.org]

Journal Journal ID (nlm-ta): Pan Afr Med J Journal ID (iso-abbrev): Pan Afr Med J Journal ID (publisher-id): PAMJ Title: The Pan African Medical Journal Publisher: The African Field Epidemiology Network ISSN (Electronic): 1937-8688 Publication date (Electronic [scienceopen.com]

Detailed attention is paid to pathophysiology, clinical symptoms and findings, all relevant imaging modalities and other tests employed to evaluate abdominal injuries at the time of admission of the trauma victim. [books.google.com]

Discussion The spleen is anatomically located near the tail of the pancreas, which partly accounts for the pathophysiology of splenic complications most commonly associated with chronic pancreatitis: pseudocysts, subcapsular hematoma, and rupture (1,2 [scielo.isciii.es]

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]

Outline • History • Etymology • Surgical Anatomy • Etiology • Pathophysiology • Types of injuries • Associated injuries • Clinical Presentation • Workup • Staging • Management • OPSI 3. [slideshare.net]

Image-guided percutaneous drainage appears to be another feasible option for large subcapsular traumatic splenic hematomas to prevent splenic rupture and obviate the need for splenectomy. [ijcasereportsandimages.com]

A controlled trial of intermittent positive pressure breathing, incentive spirometry, and deep breathing exercises in preventing pulmonary complications after abdominal surgery. Am Rev Respir Dis 1984; 130: 12-15. ‎ [books.google.it]

However, there should be a predetermined transfusion threshold (typically 2 units for isolated splenic injuries) beyond which surgery should be done to prevent morbidity and mortality. [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]