1/13. Gastric necrosis and perforation as a complication of splenectomy. Case report and related references.necrosis of the stomach after isolated splenectomy with the formation of gastrocutaneous fistula is a rare event that occurs in less than 1% of splenectomies. It is more frequent when the removal of the spleen is done because of hematological diseases. Its mortality index can reach 60% and its pathogenesis is controversial, as it may be attributed both to direct trauma of the gastric wall and to ischemic phenomena. Although the stomach may exhibit exuberant arterial blood irrigation, anatomical variations can cause a predisposition towards the appearance of potentially ischemic areas, especially after ligation of the short gastric vessels around the major curvature of the stomach. Once this is diagnosed in the immediate postoperative period, it becomes imperative to reoperate. The surgical procedure will depend on the conditions of the peritoneal cavity and patient's clinic status. The objective of this study was to report on the case of a patient submitted to splenectomy because of closed abdominal traumatism, who then presented peritonitis and percutaneous gastric fistula in the post-operative period. During the second operation, perforations were identified in anterior gastric wall where there had been signs of vascular stress. The lesion was sutured after revival of its borders, and the patient had good evolution. Prompt diagnosis and immediate treatment of this unusual complication are needed to reduce its high mortality rate.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
2/13. Complications of partial splenic embolization in cirrhotic patients.In recent years, partial splenic embolization (PSE) has been widely used in patients with cirrhosis and hypersplenism caused by portal hypertension. We investigated the complications associated with PSE cases seen in our hospital. Seventeen cases of liver cirrhosis that had undergone PSE were examined to investigate the complications associated with it. Mean infarcted area of the spleen was 66.2%. Leukocyte and platelet counts in 16 of 17 patients were seen to improve after PSE and persisted for at least one year. The most frequent side effects were abdominal pain (82.4%) and fever (94.1%). Severe side effects were seen in two of those 17 patients. One patient died from acute on chronic liver failure. The other patients contracted bacterial peritonitis and splenic abscess and needed drainage of splenic abscess before recovery. These two cases were in child-Pugh class B. In conclusions, PSE is a useful treatment for patients with cirrhosis and hypersplenism caused by portal hypertension. However, the possibility of severe complications, especially in patients with noncompensated cirrhosis, should be kept in mind.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
3/13. Complete transection of the body of the stomach resulting from blunt trauma.Gastric perforation due to blunt trauma is rare, especially in children. The authors present a case of complete transection of the stomach in a 10-year-old boy who was thrown across the steel back of a seat in a school bus. Associated injuries included hematoma, a torn spleen, a seromuscular tear of the duodenojejunal flexure and complete transection of the pancreas and rectus abdominis muscle. The boy's postoperative course was complicated by the development of peritonitis with abscess formation and a pancreatic fistula. To the author's knowledge this is The first case of complete transection of the stomach, due to blunt trauma reported in the English literature.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
4/13. Ultrasound in emergency patients: better detection of free intraabdominal fluids by the use of tissue harmonic imaging.BACKGROUND: Ultrasound examination is one of the main investigative procedures in emergency patients who are hospitalized due to abdominal pain. Detectable free fluid collections are important hints to the definite, sometimes life-threatening diagnosis, but their detection in cases of only small amounts is difficult to perform by conventional sonography. patients AND methods: We report about 25 cases of patients who suffered from acute abdominal pain and who were presented as emergency patients to our department of ultrasound. First, the examination was performed by conventional sonography (3.4 MHz). Only with the additional tissue harmonic imaging (THI, 2.3 MHz, pulse inversion) thin borders of free fluids around the liver or other abdominal organs (gallbladder, spleen, pancreas, bowel) could be detected leading to other important diagnostic or therapeutic steps. In this way, the diagnosis of pancreatitis, cholezystitis, peritonitis, peritoneal carcinosis, ascites (liver cirrhosis, serositis, postoperative status after laparotomy), bleeding or paralytic ileus could be elucidated. CONCLUSION: THI sonography improves the detection of small amounts of free abdominal fluid collections. Therefore, this technique is helpful in the diagnostic procedure of emergency patients.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
5/13. Epidermoid cyst of the spleen presenting as a generalized peritonitis.In this report we reviewed 159 cases of epidermoid cyst of the spleen reported since 1929 and we added one case of our own with a unique clinical presentation. In these cases, the patients' age at presentation ranged from newborn to 51 years, with a mean age of 17.7 years. female-to-male ratio was 2.0 to 1.0. patients with this lesion usually present with asymptomatic abdominal mass and/or abdominal pain. Only in rare reports has there been infection (4 cases) or rupture (4 cases) of the cyst. In our case, the patient presented with an acute surgical abdomen and diffuse peritonitis. As in three of the previously reported cases associated with infection, salmonella group organisms were cultured from the cyst abscess. splenectomy is the surgical treatment of choice and the initial antibiotic regime should include salmonella coverage.- - - - - - - - - - ranking = 5keywords = spleen (Clic here for more details about this article) |
6/13. An autopsy case of cholesterol embolism following percutaneous transluminal coronary angioplasty and aortography.A 67-year-old woman with a 6-year history of angina pectoris underwent percutaneous transluminal coronary angioplasty. Just after manipulation of the guiding catheter during a second attempt at angioplasty and aortography, the patient developed intestinal obstruction with peritonitis. laparotomy was performed, and surgical specimens taken during surgery revealed necrosis and perforation of the small intestine. Microscopical examination proved that this was the result of multiple fresh cholesterol emboli in the arteries. Postoperatively, renal failure and sepsis developed, and the patient died 13 days after surgery. autopsy revealed multiple cholesterol emboli in arteries of the intestine, spleen, pancreas, liver and kidneys. This case demonstrates that cholesterol embolism can be a serious complication of percutaneous transluminal coronary angioplasty.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
7/13. peritonitis and massive granulocytic infiltration of the spleen in adult Still's disease.A case of adult Still's disease is described which, in addition to the more common manifestations, also included abdominal discomfort. Upon laparoscopy, peritonitis was disclosed; a biopsy showed massive granulocytic infiltration of the spleen which could not be attributed to an infectious disease. The patient did not improve on conventional therapeutic modalities but required intensive combination therapy consisting of high dose acetylsalicylic acid, prednisone, and slow-reacting substances before entering remission.- - - - - - - - - - ranking = 5keywords = spleen (Clic here for more details about this article) |
8/13. mineral oil embolization and lipid pneumonia in an infant treated for Hirschsprung's disease.A 5-month-old infant girl with Hirschsprung's disease died 1 month after colostomy as a result of mineral oil embolism and lipid pneumonia. She had received multiple mineral oil enemas and irrigations as treatment for impacted stools. mineral oil peritonitis was present on the surface of the bowel adjacent to the stoma and covered large portions of the surface of the liver and spleen. There was 600 cc of slightly cloudy and bloody peritoneal fluid. The peritoneal exudate contained bacteria that were associated with only a minimal inflammatory reaction. This case calls attention to a previously unreported complication of the use of mineral oil.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
9/13. Perisplenitis and perinephritis in the Curtis-Fitz-Hugh syndrome.Four cases of the Curtis-Fitz-Hugh syndrome diagnosed laparoscopically and with microbiological or serological evidence of chlamydial pelvic infection are reviewed. The case histories emphasize the part played by renal angle and left upper quadrant symptoms. In one patient the surface of the spleen was affected by the same classical inflammation normally seen on the surface of the liver. In 3 patients bilateral or left-sided renal angle pain and tenderness constituted the presenting features, or a major manifestation, and in all patients renal tract investigations were entirely normal. The patient with laparoscopic perisplenitis also had perihepatitis and pelvic inflammation, the latter being florid in all cases. Perisplenitis and perinephritis are proposed as possible additional manifestations of this syndrome.- - - - - - - - - - ranking = 1keywords = spleen (Clic here for more details about this article) |
10/13. Spontaneous bacterial peritonitis.Spontaneous bacterial peritonitis is an infection of the ascitic fluid of patients who, in general, have severe chronic liver disease. Several variants of this disease exist including bacterascites, culture-negative neutrocytic ascites, and secondary bacterial peritonitis. Spontaneous bacterial peritonitis is frequently manifested by signs and symptoms of peritonitis although the findings may be subtle; however, occasionally it may be completely without clinical manifestation. The clinician must have a high index of suspicion in order to make this diagnosis at a relatively earlier stage of infection. An abdominal paracentesis is required to make the diagnosis of spontaneous bacterial peritonitis. This paracentesis should be performed on all patients who are admitted to the hospital for ascites and should be repeated if there is any manifestation of bacterial infection during the hospitalization. patients with severe intrahepatic shunting--as manifested by marked redistribution of activity from the liver to the spleen and to the bone marrow on liver-spleen scan as well as patients with an ascitic fluid total protein concentration of less than 1 g/dl--appear to be particularly susceptible to bacterial infection of their ascites. In order to optimize the yield of ascitic fluid culture, it is probably appropriate to inject blood culture bottles with ascites at the bedside immediately after the abdominal paracentesis. The mortality of spontaneous bacterial peritonitis continues to be very high. Perhaps routine admission paracentesis and prompt empiric antibiotic therapy with a third-generation cephalosporin will decrease the mortality of this infection if the Gram stain of the ascitic fluid demonstrates bacteria or the ascitic fluid neutrophil count is greater than 250 cells/cu mm. Repeating the paracentesis after 48 hours of treatment to reculture the fluid and reassess the ascitic fluid neutrophil count appears to be the best way to assess efficacy of treatment. After 48 hours of treatment the ascitic fluid neutrophil count should be less than 50% of the original value if the antimicrobial therapy is appropriate. The optimal duration of antibiotic treatment is unknown; however, until controlled trials provide data regarding duration of treatment it is appropriate to treat with parenteral antibiotics for 10 to 14 days. research is also needed to determine if there are measures which can be taken to prevent the development of spontaneous peritonitis.- - - - - - - - - - ranking = 2keywords = spleen (Clic here for more details about this article) |
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