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Spontaneous hemorrhage from splenic tissue 13   years after total splenectomy: report of a case

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ABSTRACT

A 33-year-old man suffered sudden abdominal distension without traumatic episodes. He had undergone total splenectomy for hereditary spherocytosis 13 years ago. He was in shock, and his hemoglobin level was 10.5 g/dl. Contrast enhanced computed tomography revealed a giant mass in the left upper abdomen and extravasation of the contrast material into the mass. Excision of the mass was performed, and microscopic examination showed a giant hematoma surrounded by normal splenic tissue. We speculated that an accessory spleen or splenosis had enlarged for the 13 years and ruptured. The patient remained asymptomatic 4 months after the surgery. Spontaneous hemorrhage from accessory spleens or splenosis is extremely rare, and relevant case reports suggest that surgical resection of bleeding sites yields favorable prognosis although preoperative qualitative diagnosis seems to be difficult.

No MeSH data available.


Related in: MedlinePlus

Images of frontal sections of contrast-enhanced computed tomography at a portal phase. Red arrows show heterogeneously enhanced abdominal mass which ranges from an intramesenteric space of the transverse colon to the left upper abdomen with extension to 25 cm in the longest diameter. A yellow arrow shows extravasation of the contrast material into the mass. An arrowhead shows ascites in Douglas’ pouch
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Fig1: Images of frontal sections of contrast-enhanced computed tomography at a portal phase. Red arrows show heterogeneously enhanced abdominal mass which ranges from an intramesenteric space of the transverse colon to the left upper abdomen with extension to 25 cm in the longest diameter. A yellow arrow shows extravasation of the contrast material into the mass. An arrowhead shows ascites in Douglas’ pouch

Mentions: A 33-year-old Japanese man suffered sudden abdominal distension and visited our hospital by ambulance. He did not have any symptoms before the onset and denied histories of trauma. He had undergone cardiac surgery for arterial septal defect at 0 year old and total splenectomy for hereditary spherocytosis at 20 years old. The splenectomy was performed at another hospital, and the patient had not been clinically followed up since the surgery. He was 162-cm tall and weighted 75 kg (body mass index, 28.6). His blood pressure, pulse, oxygen saturation, and body temperature were 70/42 mmHg, 102 beats/min, 99 %, and 37.0 °C, respectively. His abdomen was considerably distended, and tenderness was observed at the left side of the abdomen. Laboratory examinations revealed intense acute inflammation (leukocyte count, 42,710/μl; C-reactive protein level, 0.80 mg/dl), anemia (hemoglobin level, 10.5 g/dl), mild liver dysfunction (total bilirubin, 3.03 mg/dl; direct bilirubin, 0.84 mg/dl), elevated levels of pancreatic enzymes (amylase, 146 IU/l; lipase, 240 U/l), and mild renal dysfunction (creatinine, 1.51 mg/dl; blood urea nitrogen, 15.4 mg/dl). Contrast-enhanced computed tomography revealed a heterogeneously enhanced abdominal mass with extension to 25 cm in the longest diameter; it ranged from an intramesenteric space of the transverse colon to the left upper quadrant of the abdomen in which the primary spleen would exist if splenectomy had not been performed. Ascites in Douglas’ pouch and extravasation of the contrast material into the mass in a portal phase were also observed (Fig. 1). We diagnosed hemorrhagic shock due to bleeding from some kind of giant neoplasm of the abdomen such as gastrointestinal stromal tumor.Fig. 1


Spontaneous hemorrhage from splenic tissue 13   years after total splenectomy: report of a case
Images of frontal sections of contrast-enhanced computed tomography at a portal phase. Red arrows show heterogeneously enhanced abdominal mass which ranges from an intramesenteric space of the transverse colon to the left upper abdomen with extension to 25 cm in the longest diameter. A yellow arrow shows extravasation of the contrast material into the mass. An arrowhead shows ascites in Douglas’ pouch
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4593983&req=5

Fig1: Images of frontal sections of contrast-enhanced computed tomography at a portal phase. Red arrows show heterogeneously enhanced abdominal mass which ranges from an intramesenteric space of the transverse colon to the left upper abdomen with extension to 25 cm in the longest diameter. A yellow arrow shows extravasation of the contrast material into the mass. An arrowhead shows ascites in Douglas’ pouch
Mentions: A 33-year-old Japanese man suffered sudden abdominal distension and visited our hospital by ambulance. He did not have any symptoms before the onset and denied histories of trauma. He had undergone cardiac surgery for arterial septal defect at 0 year old and total splenectomy for hereditary spherocytosis at 20 years old. The splenectomy was performed at another hospital, and the patient had not been clinically followed up since the surgery. He was 162-cm tall and weighted 75 kg (body mass index, 28.6). His blood pressure, pulse, oxygen saturation, and body temperature were 70/42 mmHg, 102 beats/min, 99 %, and 37.0 °C, respectively. His abdomen was considerably distended, and tenderness was observed at the left side of the abdomen. Laboratory examinations revealed intense acute inflammation (leukocyte count, 42,710/μl; C-reactive protein level, 0.80 mg/dl), anemia (hemoglobin level, 10.5 g/dl), mild liver dysfunction (total bilirubin, 3.03 mg/dl; direct bilirubin, 0.84 mg/dl), elevated levels of pancreatic enzymes (amylase, 146 IU/l; lipase, 240 U/l), and mild renal dysfunction (creatinine, 1.51 mg/dl; blood urea nitrogen, 15.4 mg/dl). Contrast-enhanced computed tomography revealed a heterogeneously enhanced abdominal mass with extension to 25 cm in the longest diameter; it ranged from an intramesenteric space of the transverse colon to the left upper quadrant of the abdomen in which the primary spleen would exist if splenectomy had not been performed. Ascites in Douglas’ pouch and extravasation of the contrast material into the mass in a portal phase were also observed (Fig. 1). We diagnosed hemorrhagic shock due to bleeding from some kind of giant neoplasm of the abdomen such as gastrointestinal stromal tumor.Fig. 1

View Article: PubMed Central

ABSTRACT

A 33-year-old man suffered sudden abdominal distension without traumatic episodes. He had undergone total splenectomy for hereditary spherocytosis 13 years ago. He was in shock, and his hemoglobin level was 10.5 g/dl. Contrast enhanced computed tomography revealed a giant mass in the left upper abdomen and extravasation of the contrast material into the mass. Excision of the mass was performed, and microscopic examination showed a giant hematoma surrounded by normal splenic tissue. We speculated that an accessory spleen or splenosis had enlarged for the 13 years and ruptured. The patient remained asymptomatic 4 months after the surgery. Spontaneous hemorrhage from accessory spleens or splenosis is extremely rare, and relevant case reports suggest that surgical resection of bleeding sites yields favorable prognosis although preoperative qualitative diagnosis seems to be difficult.

No MeSH data available.


Related in: MedlinePlus