1/8. splenic rupture as a complication of P. falciparum malaria after residence in the tropics. Report of two cases.splenic rupture is an uncommon complication of malaria, which requires urgent medical investigation, close follow-up and adequate treatment. Until present, this complication was reported more often in P. vivax infections than in infections with other species. Rupture can happen spontaneously or as a result of trauma, which may be minor and unnoticed. The diagnosis is made by physical examination, ultrasound and CT-scan. Especially in malaria endemic areas the management of splenic rupture in malaria should be focused on splenic preservation. We describe two cases of splenic rupture during a P. falciparum infection, both requiring finally splenectomy.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/8. observation of splenic trauma: when is a little too much?A 12-year-old boy was treated conservatively for a grade II splenic laceration. On discharge, he was instructed to avoid contact sports, running, and strenuous physical activity. Thirty-eight days later, after diving off the side of a swimming pool, he had abdominal pain, nausea, and diaphoresis. On admission, he was hemodynamically unstable. Results of a diagnostic lavage showed gross blood. At laparotomy, a fractured spleen was found, and splenectomy was performed. He recovered without complication. This case questions the activity restrictions placed on patients with conservatively managed splenic trauma. Avoidance of only contact sports and heavy exertion may be inadequate.- - - - - - - - - - ranking = 0.085753929200731keywords = physical (Clic here for more details about this article) |
3/8. Delayed rupture of the spleen in a patient with mandibular fracture.A case of blunt abdominal trauma with subsequent damage to and rupture of the spleen is presented. Clinical manifestations, diagnosis, and sequelae and complications of injury are discussed. This case report demonstrates the insidious nature of trauma to the spleen and the ultimate dangers of delayed rupture. Treatment and disposition of the case are discussed and recommendations for physical examination of the patient who has suffered trauma to the abdomen are outlined.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
4/8. Nonoperative management of adult splenic injury due to blunt trauma: a warning.An analysis of 11 patients with splenic injury initially receiving nonoperative treatment revealed that 73 percent subsequently required surgery for delayed hemorrhage. The influence of age and the anatomic differences between the adult's spleen and child's spleen may account for the increased incidence of delayed bleeding seen in this series. Which patients might avoid surgical intervention cannot be predicted with certainty from the mechanism of injury or the lack of early physical signs and symptoms. The corresponding medical problems that often exist with the older patient may make nonoperative management, with the inherent risk of hypotension and large transfusion requirements, inappropriate. Although not advocating immediate splenectomy, we encourage early operative intervention with splenorrhaphy. Although improved diagnostic techniques will uncover a greater incidence of splenic injury, the inability to identify the nonoperative patient remains a clinical dilemma. The true role of nonoperative management of splenic injuries in the adult and the criteria for selection need to be further defined with larger prospective series. Although this approach may be useful for some patients, its application cannot be universal, and one must be willing to accept the consequences of delayed hemorrhage.- - - - - - - - - - ranking = 0.085753929200731keywords = physical (Clic here for more details about this article) |
5/8. Surgical implications of infectious mononucleosis.A series of 50 consecutive patients admitted to the hospital with a primary diagnosis of infectious mononucleosis is reviewed, with particular emphasis on the abdominal complaints and physical findings. Forty-eight percent of the patients had abdominal pain. Abdominal symptoms were the chief complaint in 24 percent of the patients. Two cases of splenic rupture are presented. One case of spontaneous rupture of the spleen is emphasized, as there are only 18 well-documented cases of true spontaneous rupture of the spleen in infectious mononucleosis. Four young persons with infectious mononucleosis in Portland, oregon, recently bled to death at home from a ruptured spleen. Guidelines are presented to aid the surgeon in evaluating the patient with infectious mononucleosis. The risk of splenic rupture persists after the patient recovers. Recommendations are made regarding the resumption of physical activity in these young, active patients.- - - - - - - - - - ranking = 0.17150785840146keywords = physical (Clic here for more details about this article) |
6/8. Successful treatment of two brothers with congenital afibrinogenemia for splenic rupture using heat- and solvent detergent-treated fibrinogen concentrates.PURPOSE: This report describes life-threatening spontaneous splenic rupture in two brothers with congenital afibrinogenemia. patients: Two brothers, aged 11 and 14 years, had intra-abdominal bleeding due to splenic rupture confirmed by ECHO ultrasonography and computed tomography scans. RESULTS: splenectomy was performed after administration of heat- and solvent-detergent treated fibrinogen concentrates. CONCLUSIONS: Hemostatic treatment for splenic rupture using heat- and solvent detergent-treated fibrinogen concentrates was effective. Careful attention must be paid to the risk of splenic rupture during the growth spurt in physically active children with this rare coagulation disorder.- - - - - - - - - - ranking = 0.085753929200731keywords = physical (Clic here for more details about this article) |
7/8. Pathologic rupture of the spleen as the initial manifestation in acute lymphoblastic leukemia.Pathologic splenic rupture is a rare and life-threatening complication of acute leukemia. It is even more uncommon as the initial manifestation, and only a few cases has been reported in the literature. Early recognition of this complication is vital because the prognosis is fatal without immediate treatment by splenectomy. We report the case of a spontaneous spleen rupture irreversibly complicating the onset of acute lymphoblastic leukemia in a 19-year-old man, in spite of splenectomy. In our case abdominal ultrasound was a good, non-invasive diagnostic test. Therefore, we believe that the course of the underlying disease and the physical condition of the patient dramatically influenced the disease evolution.- - - - - - - - - - ranking = 0.085753929200731keywords = physical (Clic here for more details about this article) |
8/8. diagnosis of spontaneous splenic rupture with emergency ultrasonography.Rapid evaluation of the hypotensive patient in the emergency department is essential. The availability of ultrasonography in the ED, performed by emergency physicians and surgeons, has made it easier to evaluate the hypotensive trauma patient. We describe a 44-year-old man transferred to our institution from a community hospital for evaluation of syncope and hypotension with no obvious cause. On arrival the patient began to complain of slight lower abdominal pain. The patient's physical examination revealed minimal abdominal tenderness. A rapid ultrasound examination performed at bedside revealed the presence of intraperitoneal fluid. Examination of the spleen suggested likely rupture. The patient was promptly taken to surgery for splenectomy and discharged home in 4 days.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |