In malaria, splenic rupture is a serious complication potentially leading to death. Subcapsular hemorrhage of spleen is thought to be an impending sign of splenic rupture; however, the characteristics of subcapsular hemorrhage are not well known. We report 3 cases of subcapsular hemorrhage of the spleen in vivax malaria, with varying degrees of severity. Case 1 showed subcapsular hemorrhage without splenic rupture, was treated by antimalarial drug without any procedure. The healing process of the patient's spleen was monitored through 6 computed tomography follow-up examinations, over 118 days. Case 2 presented subcapsular hemorrhage with splenic rupture, treated only with an antimalarial drug. Case 3 showed subcapsular hemorrhage with splenic rupture and hypotension, treated using splenic artery embolization. They all recovered from subcapsular hemorrhage without any other complications. These 3 cases reveal the process of subcapsular hemorrhage leading to rupture and a potentially fatal outcome. The treatment plan of subcapsular hemorrhage should be determined carefully considering the vital signs, changes in hemoglobin, and bleeding tendency.
Fatal Outcome ; Follow-Up Studies ; Hemorrhage ; Hypotension ; Malaria ; Malaria, Vivax ; Plasmodium vivax ; Rupture ; Spleen ; Splenic Artery ; Splenic Rupture ; Vital Signs

Atraumatic splenic rupture (ASR) in a patient undergoing peritoneal dialysis (PD) is uncommon, but can be life-threatening. According to recent systematic reviews, the major causes of ASR are 1) neoplastic (30.3%), 2) infectious (27.3%), 3) non-infectious inflammatory (20.0%), 4) iatrogenic (9.2%), 5) mechanical (6.8%), and 6) idiopathic (6.4%). It is diagnosed by imaging studies, most commonly ultrasonography and computed tomography (CT). Due to its rarity, the early diagnosis of ASR is difficult, and no standard treatment has been described. Here, we report a case of idiopathic ASR in a patient undergoing PD. The diagnosis was established by abdominal CT scan, and splenectomy was performed. Thus, hemoperitoneum in a PD patient should raise suspicion of ASR. Early diagnosis and appropriate treatment will lead to a better outcome.
Diagnosis ; Early Diagnosis ; Hemoperitoneum ; Humans ; Peritoneal Dialysis ; Splenectomy ; Splenic Rupture ; Tomography, X-Ray Computed ; Ultrasonography

A 19-year-old otherwise healthy male presented to the Emergency Department with left upper quadrant abdominal pain having felt a “pop” in his abdomen which was followed by nausea and lightheadedness. There was no evidence of trauma but 3 weeks earlier he began with symptoms of a sore throat and nasal congestion without cough. On subsequent investigation, given the patient's acute abdominal pain, abnormal vitals and a non-diagnostic computed tomography scan, an emergent exploratory laparotomy was performed. There was 600 mL of blood evacuated from the abdomen. A 643-gram inflamed and ruptured spleen was identified and removed, and follow-up lab work was positive for heterophile antibody. This report describes spontaneous splenic rupture caused by infectious mononucleosis and compares characteristics of traumatic versus non-traumatic cases.
Abdomen ; Abdominal Pain ; Cough ; Dizziness ; Emergency Service, Hospital ; Estrogens, Conjugated (USP) ; Follow-Up Studies ; Herpesvirus 4, Human ; Humans ; Infectious Mononucleosis ; Laparotomy ; Male ; Nausea ; Pharyngitis ; Spleen ; Splenectomy ; Splenic Rupture ; Young Adult

Epstein-Barr virus (EBV) infection can be presented with various clinical manifestations and different levels of severity when infected. Infectious mononucleosis, which is most commonly caused by EBV infection in children and adolescents, is a clinical syndrome characterized by fatigue, malaise, fever, sore throat, and generalized lymphadenopathy. But rarely, patients with infectious mononucleosis may present with gastrointestinal symptoms and complicated by gastritis, splenic infarction, and splenic rupture. We encountered a 16-year-old girl who presented with fever, fatigue, and epigastric pain. Splenic infarction and EBV-associated gastritis were diagnosed by using esophagogastroduodenoscopy and abdominal computed tomography. Endoscopy revealed a generalized hyperemic nodular lesion in the stomach, and the biopsy findings were chronic gastritis with erosion and positive in situ hybridization for EBV. As splenic infarction and acute gastritis are rare in infectious mononucleosis and are prone to be overlooked, we must consider these complications when an infectious mononucleosis patient presents with gastrointestinal symptom.
Adolescent ; Biopsy ; Child ; Endoscopy ; Endoscopy, Digestive System ; Epstein-Barr Virus Infections ; Fatigue ; Female ; Fever ; Gastritis* ; Herpesvirus 4, Human* ; Humans ; In Situ Hybridization ; Infectious Mononucleosis ; Lymphatic Diseases ; Pharyngitis ; Splenic Infarction* ; Splenic Rupture ; Stomach

PURPOSE: Laparoscopic gastrectomy is accepted as a standard treatment for patients with early gastric cancer in Korea, Japan, and China. However, duodenal stump leakage remains a fatal complication after gastrectomy. We conducted a prospective phase II study to evaluate the safety of the new technique of laparoscopic reinforcement suture (LARS) on the duodenal stump. MATERIALS AND METHODS: The estimated number of patients required for this study was 100 for a period of 18 months. Inclusion criteria were histologically proven gastric adenocarcinoma treated with laparoscopic distal or total gastrectomy and Billroth II or Roux-en-Y reconstruction. The primary endpoint was the incidence of duodenal stump leakage within the first 30 postoperative days. The secondary endpoints were early postoperative outcomes until discharge. RESULTS: One hundred patients were enrolled between February 2016 and March 2017. The study groups consisted of 65 male and 35 female patients with a mean age (years) of 62.3. Of these, 63 (63%) patients had comorbidities. The mean number of retrieved lymph nodes was 38. The mean operation time was 145 minutes including 7.8 minutes of mean LARS time. There was no occurrence of duodenal stump leakage. Thirteen complications occurred, with one case of reoperation for splenic artery rupture and one case of mortality. CONCLUSIONS: Based on the results of this prospective phase II study, LARS can be safely performed in a short operation period without development of duodenal stump leakage. A future randomized prospective controlled trial is required to confirm the surgical benefit of LARS compared to non-LARS.
Adenocarcinoma ; Arm* ; China ; Comorbidity ; Duodenum ; Female ; Gastrectomy* ; Gastroenterostomy ; Humans ; Incidence ; Japan ; Korea ; Laparoscopy ; Lymph Nodes ; Male ; Mortality ; Prospective Studies* ; Reoperation ; Rupture ; Splenic Artery ; Stomach Neoplasms* ; Sutures*

An ischemia-reperfusion injury of the intestine due to blunt trauma is very rare. Low blood flow can result in an incarceration and an ischemia-reperfusion injury of the small intestine. A 63-year-old woman fell, producing a splenic rupture. Despite the successful angio-embolization of the splenic rupture, the patient continued to suffer from hypotension. During laparotomy to identify the bowel injury, no intestinal perforation was found. However, we found a hemorrhagic infarction of the small intestine with congestion of the submucosal blood vessels. The part of bowel with the hemorrhagic infarction was resected and reconstructed with a jejuno-colic anastomosis. After surgery, she recovered from the trauma and was discharged without complications. We present this ischemia-reperfusion injury of the intestine due to blunt trauma. Meticulous examination and computed tomography scan is mandatory for diagnosis and assessment of treatment outcome.
Blood Vessels ; Diagnosis ; Estrogens, Conjugated (USP) ; Female ; Humans ; Hypotension ; Infarction ; Intestinal Perforation ; Intestine, Small* ; Intestines ; Laparotomy ; Middle Aged ; Reperfusion Injury ; Splenic Rupture ; Treatment Outcome

Splenic artery aneurysm is the third most common type of intra-abdominal aneurysm, with a prevalence rate of 0.01% to 10.4% in the general population. Splenic artery aneurysm is usually asymptomatic and is typically detected by chance and does not require surgical management; however, if rupture occurs, although rare, the patient's situation can become critical. We report our experience with a man who presented with left flank and left shoulder pain. His symptoms were caused by multiple hematomas confined to the spleen, but 2 days after admission, he developed delayed hemoperitoneum and required surgical management. We believe that his condition was due to delayed intraperitoneal bleeding called the double-rupture phenomenon; emergency physicians must consider this phenomenon when taking care of splenic artery aneurysm patients.
Aneurysm* ; Emergencies ; Hematoma ; Hemoperitoneum ; Hemorrhage ; Humans ; Prevalence ; Rupture ; Shoulder Pain ; Spleen ; Splenic Artery*

No abstract available.
Aneurysm, False* ; Pancreatitis* ; Splenic Artery* ; Splenic Rupture*

Hemosuccus pancreaticus, defined as bleeding from the papilla of Vater via the pancreatic duct, is a rare cause of recurrent upper gastrointestinal bleeding. We report the case of a 67-year-old man with recurrent gastrointestinal bleeding, who was subsequently diagnosed with hemosuccus pancreaticus caused by rupture of a true splenic artery aneurysm. The patient had chronic pancreatitis after considerable delay and unnecessary surgical small bowel exploration. The patient was cured with distal pancreatectomy because concomitant arcuate ligament syndrome precluded the angiographic approach via the celiac trunk, and tortuous dilatation of the distal pancreatic duct could not exclude the main duct type of intraductal papillary mucinous neoplasm (IPMN). In the surgical specimen, the pancreatic duct contained a hematoma and was lined by normal epithelium, indicating rupture of the splenic artery aneurysm that bled into the pancreatic duct.
Aged ; Aneurysm* ; Dilatation ; Epithelium ; Gastrointestinal Hemorrhage* ; Hematoma ; Hemorrhage ; Humans ; Ligaments ; Mucins ; Pancreatectomy ; Pancreatic Ducts ; Pancreatitis, Chronic ; Rupture ; Splenic Artery*

We present the case of a 27-year-old female who presented in hypovolemic shock due to splenic rupture without apparent cause. The patient underwent an open splenectomy followed by an uneventful recovery. Post-operatively the patient could recall no trauma, and exams for viral and neoplastic etiologies were unrevealing. Spontaneous splenic rupture is a rare condition requiring a high index of suspicion, and patients should be managed with prompt splenectomy.
Adult ; Female ; Humans ; Rare Diseases ; Rupture, Spontaneous ; Shock ; Spleen ; Splenectomy ; Splenic Rupture*