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Sub capsular splenectomy for delayed spontaneous splenic rupture in a case of sickle cell anemia.

Sharma D - World J Emerg Surg (2009)

Bottom Line: Splenic ruptures are mostly due to trauma and manifest at the moment of injury with symptoms of acute intraperitoneal hemorrhage and shock.Spontaneous/pathological and delayed rupture of the spleen is not unknown.A case of delayed spontaneous splenic rupture in a case of sickle cell anemia is being reported, which was treated with sub capsular splenectomy (from within the pseudo capsule formed due to inflammation).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Government NSCB Medical College, Jabalpur (MP) 482 003, INDIA . dhanshar@gmail.com.

ABSTRACT
Splenic ruptures are mostly due to trauma and manifest at the moment of injury with symptoms of acute intraperitoneal hemorrhage and shock. Spontaneous/pathological and delayed rupture of the spleen is not unknown. A case of delayed spontaneous splenic rupture in a case of sickle cell anemia is being reported, which was treated with sub capsular splenectomy (from within the pseudo capsule formed due to inflammation).

No MeSH data available.


Related in: MedlinePlus

Thickened and densely adherent splenic capsule.
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Figure 3: Thickened and densely adherent splenic capsule.

Mentions: KSM, a 50 year old man presented with severe pain over left hypochondrium and left lower chest wall, moderate fever on and off for one month. Pain increased on deep inspiration and radiated to left shoulder. There was no history of trauma or any disease process. On examination, only positive sign was some tenderness over left hypochondrium. Ultrasonography revealed chronic rupture of spleen with some hemoperitonem in the perisplenic area and small pleural effusion. (Figure 1) Biochemical workup did not show any abnormality, except a positive test for sickle cell trait. Patient was taken up for splenectomy because of severe pain. On exploratory laparotomy left quadrant was found cordoned off by omental adhesions. On taking down the adhesions, 250 ml of darkish blood was drained form the area around the spleen. Dense adhesions prevented separation of spleen from diaphragm, left lobe of liver, stomach and left flexure of colon. Attempt was made to ligate splenic vessels, by opening the lesser sac, but dense adhesions prevented success of this step. Sub capsular splenectomy (SCS, from within the pseudo capsule formed due to inflammation) starting from near the diaphragm, was performed so as to avoid inadvertent iatrogenic trauma to neighboring structures. (Figure 2) Splenic vessels were identified inside the capsule and ligated by transfixing en-mass with 1-0 silk. Splenic capsule was found thickened and densely adherent to neighboring structures. (Figure 3) Abdomen was closed after a thorough lavage and a tube drain was inserted in the left sub diaphragmatic region. Removed spleen (Figure 4) was sent for histopatholgical examination.


Sub capsular splenectomy for delayed spontaneous splenic rupture in a case of sickle cell anemia.

Sharma D - World J Emerg Surg (2009)

Thickened and densely adherent splenic capsule.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2683798&req=5

Figure 3: Thickened and densely adherent splenic capsule.
Mentions: KSM, a 50 year old man presented with severe pain over left hypochondrium and left lower chest wall, moderate fever on and off for one month. Pain increased on deep inspiration and radiated to left shoulder. There was no history of trauma or any disease process. On examination, only positive sign was some tenderness over left hypochondrium. Ultrasonography revealed chronic rupture of spleen with some hemoperitonem in the perisplenic area and small pleural effusion. (Figure 1) Biochemical workup did not show any abnormality, except a positive test for sickle cell trait. Patient was taken up for splenectomy because of severe pain. On exploratory laparotomy left quadrant was found cordoned off by omental adhesions. On taking down the adhesions, 250 ml of darkish blood was drained form the area around the spleen. Dense adhesions prevented separation of spleen from diaphragm, left lobe of liver, stomach and left flexure of colon. Attempt was made to ligate splenic vessels, by opening the lesser sac, but dense adhesions prevented success of this step. Sub capsular splenectomy (SCS, from within the pseudo capsule formed due to inflammation) starting from near the diaphragm, was performed so as to avoid inadvertent iatrogenic trauma to neighboring structures. (Figure 2) Splenic vessels were identified inside the capsule and ligated by transfixing en-mass with 1-0 silk. Splenic capsule was found thickened and densely adherent to neighboring structures. (Figure 3) Abdomen was closed after a thorough lavage and a tube drain was inserted in the left sub diaphragmatic region. Removed spleen (Figure 4) was sent for histopatholgical examination.

Bottom Line: Splenic ruptures are mostly due to trauma and manifest at the moment of injury with symptoms of acute intraperitoneal hemorrhage and shock.Spontaneous/pathological and delayed rupture of the spleen is not unknown.A case of delayed spontaneous splenic rupture in a case of sickle cell anemia is being reported, which was treated with sub capsular splenectomy (from within the pseudo capsule formed due to inflammation).

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Government NSCB Medical College, Jabalpur (MP) 482 003, INDIA . dhanshar@gmail.com.

ABSTRACT
Splenic ruptures are mostly due to trauma and manifest at the moment of injury with symptoms of acute intraperitoneal hemorrhage and shock. Spontaneous/pathological and delayed rupture of the spleen is not unknown. A case of delayed spontaneous splenic rupture in a case of sickle cell anemia is being reported, which was treated with sub capsular splenectomy (from within the pseudo capsule formed due to inflammation).

No MeSH data available.


Related in: MedlinePlus