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Spontaneous splenic rupture during the recovery phase of dengue fever.

de Silva WT, Gunasekera M - BMC Res Notes (2015)

Bottom Line: The patient was resuscitated and Emergency laparotomy with splenectomy was performed.The outcome was excellent with the patient making a complete recovery.Early diagnosis and intervention can prevent mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, General Hospital Kalutara, Kalutara, Sri Lanka. thathya_d@yahoo.com.

ABSTRACT

Background: Spontaneous splenic rupture is a rare but known complication of dengue fever. Previously reported cases have occurred early during the course of the disease and most cases have led to a fatal outcome. Here we report a case of spontaneous splenic rupture in a patient with dengue fever, which occurred during the recovery phase of the illness.

Case presentation: A 28-year-old Sinhalese, Sri Lankan man presented with a history of fever, myalgia and vomiting of 4 days duration. Investigations revealed a diagnosis of dengue fever with no signs of plasma leakage. He was managed in the ward as per local protocol. During the recovery phase the patient developed severe abdominal distention with circulatory failure. Radiology revealed splenic rupture with massive amounts of abdominal free fluid. The patient was resuscitated and Emergency laparotomy with splenectomy was performed. The outcome was excellent with the patient making a complete recovery.

Conclusion: Although splenic rupture is a known complication of dengue fever it may be manifested late in the disease process. A high degree of suspicion should be maintained and patients must be monitored even during the recovery phase of dengue fever. Early diagnosis and intervention can prevent mortality.

No MeSH data available.


Related in: MedlinePlus

Post-splenectomy—splenic laceration close to upper pole.
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Fig2: Post-splenectomy—splenic laceration close to upper pole.

Mentions: On day 8, despite being afebrile, he complained of severe generalized abdominal pain. Examination revealed a distended, severely tender abdomen. He was clinically pale. His blood pressure dropped to 80/60. Pulse rate 140 bpm. Investigations—Hb 8.8 g/dl, PCV 26%, WBC 4,000/mm3, platelets 90,000/mm3. His coagulation profile was normal. A concealed bleed was suspected and the patient was transfused with two pints of packed red cells. An ultrasound scan of the abdomen at that time revealed a large amount of free fluid in the pelvis and Morrison’s pouch. A contrast enhanced computed tomography (CT) scan of the abdomen was performed (Figure 1) which revealed free fluid in the peritoneal cavity with a per-splenic haematoma. The patient was taken over to the surgical ward and an emergency laparotomy was performed. There was approximately 4 l of blood in the peritoneal cavity and a 4 cm splenic laceration close to the upper pole (Figure 2). Splenectomy was done. Four pints of packed rec cells were transfused during the surgery. Post Op day 1 the patient was haemodynamically stable. Hb 11.5 g/dl, PCV 35, WBC 14,000/mm3, platelets 183,000/mm3. The splenic histology was normal. The patient was discharged home 5 days following surgery.Figure 1


Spontaneous splenic rupture during the recovery phase of dengue fever.

de Silva WT, Gunasekera M - BMC Res Notes (2015)

Post-splenectomy—splenic laceration close to upper pole.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4489041&req=5

Fig2: Post-splenectomy—splenic laceration close to upper pole.
Mentions: On day 8, despite being afebrile, he complained of severe generalized abdominal pain. Examination revealed a distended, severely tender abdomen. He was clinically pale. His blood pressure dropped to 80/60. Pulse rate 140 bpm. Investigations—Hb 8.8 g/dl, PCV 26%, WBC 4,000/mm3, platelets 90,000/mm3. His coagulation profile was normal. A concealed bleed was suspected and the patient was transfused with two pints of packed red cells. An ultrasound scan of the abdomen at that time revealed a large amount of free fluid in the pelvis and Morrison’s pouch. A contrast enhanced computed tomography (CT) scan of the abdomen was performed (Figure 1) which revealed free fluid in the peritoneal cavity with a per-splenic haematoma. The patient was taken over to the surgical ward and an emergency laparotomy was performed. There was approximately 4 l of blood in the peritoneal cavity and a 4 cm splenic laceration close to the upper pole (Figure 2). Splenectomy was done. Four pints of packed rec cells were transfused during the surgery. Post Op day 1 the patient was haemodynamically stable. Hb 11.5 g/dl, PCV 35, WBC 14,000/mm3, platelets 183,000/mm3. The splenic histology was normal. The patient was discharged home 5 days following surgery.Figure 1

Bottom Line: The patient was resuscitated and Emergency laparotomy with splenectomy was performed.The outcome was excellent with the patient making a complete recovery.Early diagnosis and intervention can prevent mortality.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, General Hospital Kalutara, Kalutara, Sri Lanka. thathya_d@yahoo.com.

ABSTRACT

Background: Spontaneous splenic rupture is a rare but known complication of dengue fever. Previously reported cases have occurred early during the course of the disease and most cases have led to a fatal outcome. Here we report a case of spontaneous splenic rupture in a patient with dengue fever, which occurred during the recovery phase of the illness.

Case presentation: A 28-year-old Sinhalese, Sri Lankan man presented with a history of fever, myalgia and vomiting of 4 days duration. Investigations revealed a diagnosis of dengue fever with no signs of plasma leakage. He was managed in the ward as per local protocol. During the recovery phase the patient developed severe abdominal distention with circulatory failure. Radiology revealed splenic rupture with massive amounts of abdominal free fluid. The patient was resuscitated and Emergency laparotomy with splenectomy was performed. The outcome was excellent with the patient making a complete recovery.

Conclusion: Although splenic rupture is a known complication of dengue fever it may be manifested late in the disease process. A high degree of suspicion should be maintained and patients must be monitored even during the recovery phase of dengue fever. Early diagnosis and intervention can prevent mortality.

No MeSH data available.


Related in: MedlinePlus