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A case of intrathoracic stomach and spleen after aortic repair: an unusual complication.

de Haas SA, van der Weijden PK, Steenvoorde P, Joosten PP - J Clin Med Res (2010)

Bottom Line: The patient recovered fully.The possible mechanism of this severe complication is discussed and relevant literature reviewed.Aortoduodenal fistula; Complication; Intrathoracic stomach; Intrathoracic spleen.

View Article: PubMed Central - PubMed

Affiliation: Department of Intensive Care, Rijnland Hospital Leiderdorp, The Netherlands.

ABSTRACT

Unlabelled: A patient is described who presented with an intrathoracic stomach and spleen two weeks after aortic repair for an aortoduodenal fistula. At an urgent laparotomy the stomach was repositioned and the spleen removed. The patient recovered fully. The possible mechanism of this severe complication is discussed and relevant literature reviewed.

Keywords: Aortoduodenal fistula; Complication; Intrathoracic stomach; Intrathoracic spleen.

No MeSH data available.


Related in: MedlinePlus

Removal of the decapsulated spleen.
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Figure 3: Removal of the decapsulated spleen.

Mentions: The direct post-operative period was without any complications besides chylus leakage for which a medium chain triglycerides (MCT) diet was started and which resolved fully. However on the 27th post-operative day the patient complained of acute dyspnea and pain on the left thorax and in the left flank. At auscultation decreased breath sounds were heard on the left side. On the X-ray of the thorax an intrathoracic stomach was presumed (Fig. 1). For further diagnosis a CT-scan of the thorax and abdomen was performed which showed fluid collections perisplenic, perihepatic and paracolic: probably caused by a rupture of the spleen with active bleeding. Furthermore an intrathoracic positioned stomach on the left side of the thorax with a mediastinal shift to the right and total atelectasis of the left lower lobe was diagnosed. A re-laparotomy was performed: the spleen and stomach were indeed intrathoracic. The spleen was completely decapsulated and had to be removed (Fig. 2), the stomach could be repositioned (Fig. 3). A defect in the diaphragm was closed with simple Vicryl sutures. Besides a pulmonary embolism the post-operative period was uneventful. The patient could be discharged from the hospital 31 days after the re-laparotomy and is now in a good clinical condition.


A case of intrathoracic stomach and spleen after aortic repair: an unusual complication.

de Haas SA, van der Weijden PK, Steenvoorde P, Joosten PP - J Clin Med Res (2010)

Removal of the decapsulated spleen.
© Copyright Policy - open access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3104639&req=5

Figure 3: Removal of the decapsulated spleen.
Mentions: The direct post-operative period was without any complications besides chylus leakage for which a medium chain triglycerides (MCT) diet was started and which resolved fully. However on the 27th post-operative day the patient complained of acute dyspnea and pain on the left thorax and in the left flank. At auscultation decreased breath sounds were heard on the left side. On the X-ray of the thorax an intrathoracic stomach was presumed (Fig. 1). For further diagnosis a CT-scan of the thorax and abdomen was performed which showed fluid collections perisplenic, perihepatic and paracolic: probably caused by a rupture of the spleen with active bleeding. Furthermore an intrathoracic positioned stomach on the left side of the thorax with a mediastinal shift to the right and total atelectasis of the left lower lobe was diagnosed. A re-laparotomy was performed: the spleen and stomach were indeed intrathoracic. The spleen was completely decapsulated and had to be removed (Fig. 2), the stomach could be repositioned (Fig. 3). A defect in the diaphragm was closed with simple Vicryl sutures. Besides a pulmonary embolism the post-operative period was uneventful. The patient could be discharged from the hospital 31 days after the re-laparotomy and is now in a good clinical condition.

Bottom Line: The patient recovered fully.The possible mechanism of this severe complication is discussed and relevant literature reviewed.Aortoduodenal fistula; Complication; Intrathoracic stomach; Intrathoracic spleen.

View Article: PubMed Central - PubMed

Affiliation: Department of Intensive Care, Rijnland Hospital Leiderdorp, The Netherlands.

ABSTRACT

Unlabelled: A patient is described who presented with an intrathoracic stomach and spleen two weeks after aortic repair for an aortoduodenal fistula. At an urgent laparotomy the stomach was repositioned and the spleen removed. The patient recovered fully. The possible mechanism of this severe complication is discussed and relevant literature reviewed.

Keywords: Aortoduodenal fistula; Complication; Intrathoracic stomach; Intrathoracic spleen.

No MeSH data available.


Related in: MedlinePlus