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]

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]

• Fever

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

  On day-18, he had fever and subcostal pain. Clinically, he had mild left subcostal tenderness with no masses. [ijcasereportsandimages.com]

  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]

• 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

  In the tropics, the most common causes of massive splenomegaly include malaria (hyper-reactive malaria), schistosomiasis, and visceral leishmaniasis [ 14 ]. [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]

• 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]

  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

  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. [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]

• Chronic Abdominal Pain

  He had recently been recumbent due to chronic abdominal pain. On arrival he was unwell. Baseline observations revealed an oxygen saturation of 87% on room air, pulse 115 bpm and blood pressure 86/57 mm Hg. [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

  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 spleen is involved Vitals [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]

  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

  Altered Level of Consciousness ) Consider at 24-48 hours if high grade Splenic Injury (Grade 3 or higher) Indications for surgical intervention Continued Hemoglobin decrease or need for repeated Blood Transfusion Hemodynamic instability (e.g. [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]

  Plain abdominal radiographs can show enlargement of the spleen with medial displacement of the gastric bubble and elevation of the left hemidiaphragm with impaired motion. 8 Angiographic findings include extravasation of contrast, a “mottled” parenchymal [abdominalsurg.org]

  Sonogram of an enlarged spleen (D1 indicates 34 cm length) secondary to chronic lymphatic leukemia. D2 indicates width. Case of splenomegaly in which the upper pole of the spleen touches the left lobe of the liver (arrow). [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]

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

Articles include: Treatment of Aortic Aneurysms; Bariatric Surgical Procedures, Repeat Cesarean Deliveries; Thoracic and Cardiovascular Surgery; Abdominal and Pelvic Viscera; Abdominal, Pelvic Surgical and Post-procedural Foreign Bodies; Thorax; Kidneys [books.google.de]

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

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

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]

Its pathophysiology is linked to the formation of a subcapsular hematoma. Upon rupture, patients present with features of shock and peritonitis and in most cases (95%), computed tomography (CT) scan detects the splenic injury. [readbyqxmd.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]

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]

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]

Grade 3 spleen prevention-mesh splenorrhaphy. Available: (assessed 30 Mar 2012) 21.0 21.1 Shultz SJ, Houglum PA, Perrin DH. Examination of Musculoskeletal Injuries, 2nd ed. Champaign, IL, 2005. p. 570-571 [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]