Spleen rupture

Zimmer BM, Berdel WE, Ludwig WD, Notter M, Remi B, Thiel E. Fatal spleen rupture dmmg mduction chemotherapy with rh GM-CSF primmg for acute monocytic leukemia. Clinical case report and in vitro studies. Leuk Res 1993 17(3) 277-83. 

Palpate abdomen carefully to avoid spleen rupture A... 

Plasmodium vivax (benign tertian) is the most prevaient form of malaria. It has an incubation period of 1 to 4 weeks (average, 2 weeks). This form of maiaria can cause spleen rupture and anemia. Reiapses (renewed manifestations of erythrocytic infection) can occur. This results from the periodic reiease of dormant parasites (hypnozoites) from the iiver cells. The erythrocytic forms generaiiy are considered to be susceptibie to treatment. 

Percutaneous splenoportography has lost its importance. Should a direct procedure be indicated, laparoscopic splenoportography is a possible alternative. Recently, a new technique has been described. (134) The percutaneous splenic puncture is performed using a thin needle under screen control, with the needle directed at the splenic hilus. The pressure of the splenic pulp can be measured directly in order to estimate the portal vein pressure. Contrast medium is injected manually or by a special device. From this depot in the red pulp, the splenic vein, the portal vein and the intrahepatic branches of the portal vein are contrasted within a few seconds, (s. fig. 8.12) Complications resulting from percutaneous splenoportography include afterbleeding from the spleen, bilateral rupture of the spleen, arterial aneurysms and a.v. shunts — these complications are serious in nature, but rare. Contraindications for the procedure should be carefully observed, (s. tab. 8.6)... 

Falzetti F, Aversa F, Minelli O, Tabilio A. Spontaneous rupture of spleen during peripheral blood stem-cell mobilisation in a healthy donor. Lancet 1999 353(9152) 555. 

Note (1) Number of animals in experiment (2) number of being injured (3) myocardial blooding (4) myocardial necrosis (5) mild (6) medium (7) severe (8) mild (9) medium (10) severe (11) empsyxis (12) ruptured ear drum (13) blooding of other organs (14) bladder (15) stomach (16) epinephros (17) spleen (18) brain (19) severe (20) medium (21) mild (22) no... 

Examples include a cerebrovascular accident in a patient with atrial flutter who was not treated with anticoagulants, overwhelming sepsis.. .in a patient with signs of intestinal obstruction that was untreated for 24 hours, and brain damage from hypotension due to blood loss from unrecognized rupture of the spleen. 

Smith JS Jr, Cooney RN, Mucha P Jr (1996) Nonoperative management of the ruptured spleen a revalidation of criteria. Surgery 120 745-751... 

Wholey MH, Chamorro HA, Rao G, Chapman W (1978) Splenic infarction and spontaneous rupture of the spleen after therapeutic embolization. Cardiovasc Radiol 1 249-253... 

Other comphcations which adversely affect prognosis are thromboses of portal and splenic veins, and spontaneous or tramnatic rupture of the spleen. The latter occurrence has been described in a subject who up to that time was asymptomatic for the disease. 

Both organs are fragile and care must be taken when performing these techniques. A splenic pump should not be performed on an enlarged spleen because of the danger of rupture. Compression ofthe rib cage in instances of hepatitis may cause damage to the liver. 

On unenhanced CT scan, angiosarcomas have a non-specific low-attenuation appearance. However, hyperdense areas are sometimes observed within the lesions due to hemorrhage or in non-tumorous liver due to Thorotrast deposit. Thorotrast accumulates as well in lymph nodes and spleen. In cases where remote hemorrhage occurred, necrotic or cystic areas maybe noted within the angiosarcoma (Fig. 17.2). In the case of rupture of hepatic angiosarcoma, the diagnosis is ascertained by demonstrating free intraperitoneal fluid and a focal... 

Injury to solid organs may include liver rupture and disruption of the spleen, kidneys or diaphragm. The shock wave causes damage as a result of violent displacement, and subcapsular haemorrhage, capsular rupture or parenchymal fracture may occur. These injuries are managed in the conventional way. If in doubt, it is always safer to perform a laparotomy than to wait until a patient has signs of peritonitis or systemic sepsis (Box 3.19). Late fibrosis and luminal stricturing may occur. 

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