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]

The present study report a two day old infant who presented to us in shok with severe pallor and abdominal distension. [link.springer.com]

Patients who have been anticoagulated or have undergone multiple previous colonoscopies also have a higher risk of injury. 2,3 Presentation and diagnosis Most patients who suffer splenic rupture following colonoscopy present with abdominal pain within [mdmag.com]

• 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]

  However, patients with splenomegaly due to anemia like the one discussed above are more vulnerable to splenic trauma. [e-ultrasonography.org]

• 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]

• Fever

  He reported no previous trauma, fever, headache, fatigue, myalgia, arthralgia, skin alterations, or comorbidities. [ncbi.nlm.nih.gov]

  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]

• Chest Wall Pain

  On day 5, she began reporting severe left chest-wall pain... [readbyqxmd.com]

• Abdominal Pain

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

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

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

• 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]

  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]

  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]

  Minor hemorrhage often presents as upper left quadrant pain. [en.wikipedia.org]

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

• Chronic Abdominal Pain

  He was known to have chronic pancreatitis and a pancreatic pseudocyst. He had recently been recumbent due to chronic abdominal pain. On arrival he was unwell. [readbyqxmd.com]

• Epigastric Mass

  The clinical picture was marked by spontaneously painful epigastric mass, evolved over the past 48 hours. [readbyqxmd.com]

• 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]

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]

  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]

  […] 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]

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

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

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

Conservative treatment continued for 10 days and till complaining of pain. Follow-up CT scan showed no improvement. [ijcasereportsandimages.com]

[ edit ] Treatment has traditionally been splenectomy. [en.wikipedia.org]

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]

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

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

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]

Etiology Although a definitive etiology of splenic injury following fiberoptic colonoscopy has yet to be established, certain associations have been made. [mdmag.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]

[…] 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]

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]

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]

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 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]

After a splenectomy, certain precautions are needed to prevent infections (see Asplenia ). [merckmanuals.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]