1
|
Dalrymple A, Tan L, Byard RW. Unexpected death involving the spleen - an overview. MEDICINE, SCIENCE, AND THE LAW 2023; 63:316-323. [PMID: 37537888 DOI: 10.1177/00258024231191828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
The spleen is located in the left upper quadrant of the abdominal cavity and has both immunological and haematological functions. A variety of quite different entities may be associated with sudden death due to splenic involvement. These range from simple traumatic disruption of the parenchyma of a normal spleen with marked intra-abdominal haemorrhage, to conditions such as malaria and infectious mononucleosis where splenomegaly predisposes to rupture. Haematological diseases such as malignancies and haemoglobinopathies may causes sudden death due to haemorrhage or red cell sequestration. Asplenia or polysplenia may be associated with significant congenital heart disease. Hyposplenia, both structural and functional, may also result in rapid demise from sometimes unusual bacterial infections. Vascular abnormalities causing death include entities such as splenic artery aneurysms. Thus, deaths from splenic pathology may be due to localised issues or may be part of more generalised disease. For this reason the autopsy in cases of splenic-associated deaths must be comprehensive and include special testing such as microbiological screening and/or haematologic/genetic evaluation.
Collapse
Affiliation(s)
- Alice Dalrymple
- Flinders University, Bedford Park Adelaide, South Australia
- Forensic Science SA, Adelaide, South Australia
| | - Luzern Tan
- Adelaide School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Roger W Byard
- Forensic Science SA, Adelaide, South Australia
- Adelaide School of Medicine, The University of Adelaide, Adelaide, Australia
| |
Collapse
|
2
|
Dias LR, Caldas JP, Teixeira JPA, Gomes V, Babo A, Faustino AS, Baptista R, Valdoleiros SR, Santos L. Spontaneous splenic rupture due to falciparum malaria successfully treated with a conservative approach. Parasitol Int 2023; 94:102736. [PMID: 36750153 DOI: 10.1016/j.parint.2023.102736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 01/26/2023] [Indexed: 02/07/2023]
Abstract
Malaria is frequently associated with splenomegaly. However, spontaneous splenic rupture is a rare and life-threatening complication. It is mostly seen in acute infection in non-immune adults and Plasmodium vivax and Plasmodium falciparum have been associated with the majority of cases. We describe a case of splenic rupture in an adult with complicated malaria by Plasmodium falciparum in which a conservative approach was used.
Collapse
Affiliation(s)
- Lúcia Ribeiro Dias
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal.
| | - João Paulo Caldas
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Virgília Gomes
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Alexandra Babo
- General Surgery Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Sofia Faustino
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ricardo Baptista
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Sofia R Valdoleiros
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Lurdes Santos
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|
3
|
Alani AM, Kolleri JJ, Al Ekeer A, Ibrahim ZAA. Spontaneous Splenic Rupture in Malaria Patients: Two Case Reports. Cureus 2021; 13:e20344. [PMID: 35028230 PMCID: PMC8744472 DOI: 10.7759/cureus.20344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2021] [Indexed: 11/22/2022] Open
Abstract
Atraumatic splenic rupture is a rare and life-threatening condition, if not diagnosed. We present two cases with a history of travel to endemic areas, who came to the emergency department with abdominal pain and were diagnosed to have spontaneous splenic rupture as a complication of severe malaria. Both patients were treated surgically by splenectomy. A high level of clinical suspicion is critical in every malaria patient presenting with abdominal pain, even if it is mild. Clinical imaging modalities like ultrasonography and computed tomography (CT) are crucial diagnostic tools in managing such patients.
Collapse
|
4
|
Eyerer F, Gardner JA, Devitt KA. Mantle cell lymphoma presenting with lethal atraumatic splenic rupture. Autops Case Rep 2021; 11:e2021340. [PMID: 34805009 PMCID: PMC8597805 DOI: 10.4322/acr.2021.340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/04/2021] [Indexed: 01/12/2023]
Abstract
Mantle cell lymphoma is characterized by t(11;14) with CCND1-IGH fusion and manifests with a spectrum of disease ranging from relatively indolent to aggressive. Here, we present a case of pleomorphic mantle cell lymphoma with three fusion signals that presented with lethal atraumatic splenic rupture. We discuss on the implications of variant CCND1 signal patterns as well as the epidemiology and pathophysiology of atraumatic splenic rupture.
Collapse
Affiliation(s)
- Frederick Eyerer
- University of Vermont Medical Center, Department of Pathology and Laboratory Medicine, Burlington, VT, USA.,University of Vermont, Larner College of Medicine, Burlington, VT, USA
| | - Juli-Anne Gardner
- University of Vermont Medical Center, Department of Pathology and Laboratory Medicine, Burlington, VT, USA.,University of Vermont, Larner College of Medicine, Burlington, VT, USA
| | - Katherine A Devitt
- University of Vermont Medical Center, Department of Pathology and Laboratory Medicine, Burlington, VT, USA.,University of Vermont, Larner College of Medicine, Burlington, VT, USA
| |
Collapse
|
5
|
Yağmurkaya O, Oğuz S, Kahya E, Aksoy H, Albayrak D, Sağıroğlu T. Spleen rupture due to brucellosis. Turk J Surg 2021; 37:73-75. [PMID: 34585098 DOI: 10.47717/turkjsurg.2021.3295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 11/10/2015] [Indexed: 11/23/2022]
Abstract
Brucellosis is a common zoonotic infection worldwide; it is caused by infection with the bacterial species Brucella and leads to severe diseases in humans and animals. In Turkey, this bacterial species has not been completely eradicated and is commonly found in animals (such as goats or sheep). Brucellosis can lead to various symptoms, affect multiple systems, and cause splenomegaly in the case of spleen involvement. In contrast to traumatic spleen ruptures, spontaneous spleen ruptures are rare and most commonly occur because of infectious causes. A 52-year-old man was treated at our infectious diseases clinic for Brucella endocarditis. Due to sudden abdominal pain, nausea, vomiting, and vertigo, the patient was evaluated by our team of doctors at the same clinic. The patient had widespread sensitivity in the abdominal region, as well as defense and rebound symptoms. Emergency abdominal tomography revealed a ruptured spleen and widespread hemorrhagic fluid in the abdomen. Exploration revealed multiple ruptures in the spleen capsule. The patient underwent splenectomy and did not experience any complications during the postoperative period. Spontaneous spleen rupture is a rare clinical condition that should be considered in patients who are hospitalized at internal medicine clinics for infectious, hematogenic, and metabolic causes, as well as in those who have sudden abdominal pain and hypovolemia.
Collapse
Affiliation(s)
- Orhan Yağmurkaya
- Clinic of General Surgery, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Serhat Oğuz
- Department of General Surgery, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Eyüp Kahya
- Clinic of General Surgery, Edirne Public Hospital, Edirne, Turkey
| | - Hüseyin Aksoy
- Clinic of General Surgery, Yozgat Public Hospital, Yozgat, Turkey
| | - Doğan Albayrak
- Department of General Surgery, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Tamer Sağıroğlu
- Department of General Surgery, Trakya University Faculty of Medicine, Edirne, Turkey
| |
Collapse
|
6
|
Im JH, Chung MH, Durey A, Lee JS, Kim TS, Kwon HY, Baek JH. Subcapsular Splenic Hemorrhage in Vivax Malaria. THE KOREAN JOURNAL OF PARASITOLOGY 2019; 57:405-409. [PMID: 31533407 PMCID: PMC6753294 DOI: 10.3347/kjp.2019.57.4.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 08/05/2019] [Indexed: 11/30/2022]
Abstract
In malaria, splenic rupture is a serious complication potentially leading to death. Subcapsular hemorrhage of spleen is thought to be an impending sign of splenic rupture; however, the characteristics of subcapsular hemorrhage are not well known. We report 3 cases of subcapsular hemorrhage of the spleen in vivax malaria, with varying degrees of severity. Case 1 showed subcapsular hemorrhage without splenic rupture, was treated by antimalarial drug without any procedure. The healing process of the patient's spleen was monitored through 6 computed tomography follow-up examinations, over 118 days. Case 2 presented subcapsular hemorrhage with splenic rupture, treated only with an antimalarial drug. Case 3 showed subcapsular hemorrhage with splenic rupture and hypotension, treated using splenic artery embolization. They all recovered from subcapsular hemorrhage without any other complications. These 3 cases reveal the process of subcapsular hemorrhage leading to rupture and a potentially fatal outcome. The treatment plan of subcapsular hemorrhage should be determined carefully considering the vital signs, changes in hemoglobin, and bleeding tendency.
Collapse
Affiliation(s)
- Jae Hyoung Im
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon 22332, Korea
| | - Moon-Hyun Chung
- Department of Internal Medicine, Seogwipo Medical Center, Jeju 63585, Korea
| | - Areum Durey
- Department of Emergency Medicine, Inha University School of Medicine, Incheon 22332, Korea
| | - Jin-Soo Lee
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon 22332, Korea
| | - Tong-Soo Kim
- Department of Tropical Medicine, Inha University School of Medicine, Incheon 22332, Korea
| | - Hea Yoon Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon 22332, Korea
| | - Ji Hyeon Baek
- Division of Infectious Diseases, Department of Internal Medicine, Inha University School of Medicine, Incheon 22332, Korea
| |
Collapse
|
7
|
Li S, Goyal B, Cooper JD, Abdelbaki A, Gupta N, Kumar Y. Splenic rupture from babesiosis, an emerging concern? A systematic review of current literature. Ticks Tick Borne Dis 2018; 9:1377-1382. [PMID: 29954722 DOI: 10.1016/j.ttbdis.2018.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 06/05/2018] [Accepted: 06/06/2018] [Indexed: 01/17/2023]
Abstract
Babesiosis is a relatively common tick-borne parasitic infection of erythrocytes primarily affecting the northeastern United States. Babesiosis' prevalence and presentation have earned it the monikers "malaria of the northeast" and "Nantucket fever". Clinical presentation ranges from asymptomatic infection to severe infection including acute respiratory distress syndrome (ARDS) and disseminated intravascular coagulopathy (DIC) or death. Since 2008, there have been a number of reports of splenic rupture in patients with the disease. We seek to provide a further understanding of this process, with the report of a case of splenic rupture followed by a systematic review of the current literature. We found that 87% of splenic rupture secondary to babesiosis occurred in male patients who are otherwise healthy, with an average of 56 years. Computed tomography is a reliable mode of diagnosis, and hemoperitoneum is the most common imaging finding. Patients with splenic rupture due to human babesiosis were successfully treated by various management strategies, such as conservative non-operative approach, splenic artery embolization, and splenectomy. The modality of treatment depends on patient's clinical course and hemodynamic stability, although spleen conserving strategy should be considered first whenever possible.
Collapse
Affiliation(s)
- Shuo Li
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT, 06610, United States.
| | - Bobby Goyal
- St. George's University School of Medicine, Grenada, West Indies.
| | - Joseph D Cooper
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, The Bronx, NY, 10467, United States.
| | - Ahmed Abdelbaki
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT, 06610, United States.
| | - Nishant Gupta
- Department of Radiology, Columbia University Medical Center, 630 W 168th St, New York, NY, 10032, United States.
| | - Yogesh Kumar
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, 267 Grant Street, Bridgeport, CT, 06610, United States.
| |
Collapse
|
8
|
Malik S, Saran S, Kanwar SS. Spontaneous splenic rupture in typhomalaria: A case report with review of literature. Sudan J Paediatr 2017; 17:52-56. [PMID: 29213172 PMCID: PMC5621861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Plasmodium vivax, which was previously considered 'benign', has come out with unusual severe symptoms. We, here present an unusual case of Plasmodium vivax malaria presenting with spontaneous splenic rupture with hemoperitoneum, renal and pulmonary dysfunction. Following conservative management, there was an uneventful recovery, and the patient was discharged in a good general condition.
Collapse
Affiliation(s)
- Sunil Malik
- Department of Pediatrics, Subharti medical college, Meerut, UP, India
| | - Sonal Saran
- Department of Radiology, Subharti medical college, Meerut, UP, India
- Corresponding author
| | | |
Collapse
|
9
|
Zidouh S, Jidane S, Belkouch A, Bekkali H, Belyamani L. Spontaneous splenic rupture from Plasmodium ovalae malaria. Am J Emerg Med 2016; 35:347-349. [PMID: 27887819 DOI: 10.1016/j.ajem.2016.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 10/09/2016] [Indexed: 11/26/2022] Open
Affiliation(s)
- Saad Zidouh
- Emergency department, military hospital Mohammed V Rabat, Morocco.
| | - Said Jidane
- Emergency department, military hospital Mohammed V Rabat, Morocco
| | - Ahmed Belkouch
- Emergency department, military hospital Mohammed V Rabat, Morocco
| | - Hicham Bekkali
- Emergency department, military hospital Mohammed V Rabat, Morocco
| | - Lahcen Belyamani
- Emergency department, military hospital Mohammed V Rabat, Morocco
| |
Collapse
|
10
|
Case report: spontaneous rupture of spleen in patient with Plasmodium ovale malaria. Wien Klin Wochenschr 2015; 128:74-7. [PMID: 26542132 DOI: 10.1007/s00508-015-0888-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022]
Abstract
Malaria may lead to spontaneous splenic rupture as a rare but potentially lethal complication. Most frequently, this has been reported in patients infected with Plasmodium falciparum and Plasmodium vivax, while other parasitic agents are less likely to be the cause.We report a 29-year-old British Caucasian, who after returning from a business trip in Democratic Republic Congo was diagnosed with tertian malaria caused by Plasmodium ovale.During his in-patient stay, the patient suffered a splenic rupture requiring immediate surgical intervention and splenectomy. Following this surgical intervention, there was an uneventful recovery, and the patient was discharged in a good general condition.
Collapse
|
11
|
Gazel E, Açıkgöz G, Kasap Y, Yiğman M, Güneş ZE. Spontaneous splenic rupture due to uremic coagulopathy and mortal sepsis after splenectomy. Int J Crit Illn Inj Sci 2015; 5:119-22. [PMID: 26157658 PMCID: PMC4477390 DOI: 10.4103/2229-5151.158419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Nontraumatic spontaneous splenic rupture (NSSR) has been encountered much more rarely compared with the traumatic splenic rupture. Although NSSR generally emerges in dialysis patients on account of such causes as the use of heparin during hemodialysis, uremic coagulopathy, infections, and secondary amyloidosis. Herein, we aimed to present a case of spontaneous splenic rupture which had developed soon after the inclusion of the case suffering from end-stage renal disease in routine hemodialysis program in the absence of any trauma or other prespecified risk factors for splenic rupture. A 55-year-old male patient was admitted to our hospital to have the ureteral double J stent removed. The operation was completed without any complication. Complaining an abdominal pain more prominent in the left upper abdominal quadrant in the first postoperative day, the patient underwent a through physical examination which disclosed abdominal distension, widespread tenderness, and rebound and defense positivity. The abdominal tomography depicted 122 × 114 × 95 mm lesion compatible with a hematoma. On the basis of these findings, an emergency exploratory operation was decided to be performed. Following clearance of the retroperitoneal hematoma, splenectomy was implemented. Experiencing progressive deterioration in his clinical status despite antibiotherapy, the patient unfortunately died of sepsis with multiorgan failure on the 25th postoperative day. In conclusion, NSSR is such an entity that may be missed out, can pursue variable clinical courses, and requires emergency therapy upon definitive diagnosis. The possibility of spontaneous bleedings should be kept in mind in any case with the history of hyperuricemia even in the absence of overt trauma, no matter if they are included in routine hemodialysis or not.
Collapse
Affiliation(s)
- Eymen Gazel
- Department of Urology, Turkey Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Gazel Açıkgöz
- Department of Urology, Turkey Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Yusuf Kasap
- Department of Urology, Turkey Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Metin Yiğman
- Department of Urology, Turkey Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Zeki Ender Güneş
- Department of Urology, Turkey Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
12
|
Navti LK, Ferrari U, Tange E, Parhofer KG, Pozza SBD. Height-obesity relationship in school children in Sub-Saharan Africa: results of a cross-sectional study in Cameroon. BMC Res Notes 2015; 8:98. [PMID: 25889151 PMCID: PMC4377213 DOI: 10.1186/s13104-015-1073-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 03/19/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In developed nations, taller children exhibit a greater propensity to overweight/obesity. This study investigates whether this height-adiposity relationship holds true for Cameroon children using two parameters of adiposity including body mass index (BMI) and waist circumference (WC). METHODS In 557 children (287 boys and 270 girls, mean age 9.0 ± 1.8 years) from the North West Region of Cameroon height, weight and WC were measured and BMI calculated. Variables were converted to standard deviation scores (SDS). Participants were divided into quartiles of height SDS, then mean of age and sex-standardized body fat parameters compared across quartiles. The frequency of excess adiposity was calculated within each quartile. Correlation and regression analysis were used to assess height-adiposity relationships. RESULTS Multiple comparisons indicated a significant increase in mean BMI (-0.08 to 0.65) and WC (-0.11 to 0.87) SDSs with increasing quartiles of height SDS. Frequency of overweight/obesity and abdominal overweight/obesity was highest among children with highest height SDS (30.2 - 33.1%) and lowest in their shortest peers (0.7 - 5.0%). There was a linear relationship between height SDS and BMI SDS (R(2) = 0.087, p < 0.001); height SDS and WC SDS (R(2) = 0.356, p < 0.001) among both boys and girls. CONCLUSIONS This study shows that in Cameroon just as in developed economies a higher height SDS is associated with a higher frequency of overweight/obesity. This is independent of the parameter used to evaluate overweight/obesity (BMI SDS or WC SDS).
Collapse
Affiliation(s)
- Lifoter K Navti
- CIHLMU Center for International Health at Ludwig-Maximilians-Universitaet, Munich, Germany. .,Department of Biochemistry, Catholic University of Cameroon (CATUC), P.O. Box 782, Bamenda, Cameroon.
| | - Uta Ferrari
- CIHLMU Center for International Health at Ludwig-Maximilians-Universitaet, Munich, Germany. .,Diabetes Research Group, Department of Medicine IV, Ludwig-Maximilians Universitaet, Ziemssenstr. 1, 80336, Munich, Germany.
| | - Emmanuel Tange
- Department of Food Science and Technology, Catholic University of Cameroon (CATUC), P.O. Box 782, Bamenda, Cameroon.
| | - Klaus G Parhofer
- CIHLMU Center for International Health at Ludwig-Maximilians-Universitaet, Munich, Germany. .,Department of Medicine II - Grosshadern, Ludwig-Maximilians Universitaet, Marchioninistr. 15, 81377, Munich, Germany.
| | - Susanne Bechtold-Dalla Pozza
- CIHLMU Center for International Health at Ludwig-Maximilians-Universitaet, Munich, Germany. .,Pediatric Endocrinology and Diabetology, University Children's Hospital, Ludwig-Maximilians Universitaet, Lindwurmstr. 4, 80337, Munich, Germany.
| |
Collapse
|
13
|
Soltanifar D, Carvalho B, Sultan P. Perioperative considerations of the patient with malaria. Can J Anaesth 2014; 62:304-18. [PMID: 25471683 PMCID: PMC7102007 DOI: 10.1007/s12630-014-0286-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 11/25/2014] [Indexed: 11/28/2022] Open
Abstract
Purpose Malaria is a life-threatening infectious disease caused by the Plasmodium parasite. Increased global travel has resulted in an escalation in the number of imported cases seen in developed countries. Patients with malaria may present for surgery in both endemic and non-endemic countries. This article reviews the perioperative considerations when managing patients with malaria. Source A literature review of anesthesia, perioperative care, and malaria-related articles was performed using the MEDLINE®, EMBASE™, and Web of Science databases to identify relevant articles published in English during 1945-2014. Of the 303 articles matching the search criteria, 265 were excluded based on title and abstract. Eleven of the remaining 38 articles were relevant to anesthesia/perioperative care, and 27 articles were identified as having direct relevance to critical care medicine. Principal findings The majority of imported malaria cases are caused by the falciparum species, which is associated with the greatest degree of morbidity and mortality. Various organ systems may be impacted as a consequence of changes in the structure and function of parasitized erythrocytes. Preoperative assessment should focus on establishing the species of malaria, the severity of disease, assessing the degree of end-organ impairment, and initiating treatment of malaria prior to surgery. Intravenous artesunate is the treatment of choice for severe falciparum malaria. Quinine is a second-line agent but has a narrow therapeutic index and particularly hazardous side effects. Intraoperatively, attention should focus on fluid management, dynamics of cerebral blood flow, and avoidance of hypoglycemia. Postoperative care of severe cases should ideally take place in a critical care unit as there may be ongoing requirements for multi-organ support, including renal replacement therapy, ventilation, and/or inotropic support. The safety of neuraxial anesthesia has not been well studied in the setting of malaria. Conclusions Malaria remains one of the most devastating infectious diseases worldwide. Multiple organ systems can be impacted as a consequence of changes in structure and function of parasitized erythrocytes. Safe perioperative management requires a sound knowledge of all these potential system effects.
Collapse
|
14
|
Assouakon P, Brouh Y, Kouadio AS, N’Guessan J, Brou E. Rupture de rate d’origine paludéenne. ANNALES FRANCAISES DE MEDECINE D URGENCE 2014. [DOI: 10.1007/s13341-014-0441-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
15
|
Zainoun B, Menfaa M, Naitlho A. Des douleurs abdominales. Rev Med Interne 2014; 35:75-6. [DOI: 10.1016/j.revmed.2013.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 03/19/2013] [Accepted: 04/11/2013] [Indexed: 11/27/2022]
|
16
|
Fareed MI, Mahmoud AE. Spontaneous rupture of falciparum malarial spleen presenting as hemoperitoneum, hemothorax, and hemoarthrosis. AMERICAN JOURNAL OF CASE REPORTS 2013; 14:405-8. [PMID: 24147188 PMCID: PMC3797604 DOI: 10.12659/ajcr.889382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 07/27/2013] [Indexed: 11/29/2022]
Abstract
PATIENT Male, 29 FINAL DIAGNOSIS: Spontaneous spleen rupture Symptoms: Abdominal distension • abdominal pain • abdominal tenderness • disorientation • fever • hemothorax • hip pain • reduced urine output MEDICATION - Clinical Procedure: Splenectomy Specialty: Infectious Diseases. OBJECTIVE Rare diseases. BACKGROUND Spontaneous rupture of a malarial spleen is uncommon even in the endemic regions of malaria. This may lead to delayed or missed diagnosis of splenic rupture, which may be life threatening. CASE REPORT We are reporting a patient with P. falciparum malaria who developed a spontaneous splenic rupture encountered in our department. A 29-year-old male patient with history of high grade intermittent fever with chills for 4 days followed by disorientation and reduced urine output and abdominal pain with distension associated with bilateral hip pain and dyspnea with bilateral chest pain (mainly on the left side) for 1 day. There was no history of any trauma or abnormal bleeding. Investigations revealed P. falciparum malaria, hemoperitoneum, hemothorax, and hemoarthrosis. Laparotomy confirmed hemoperitoneum with about 1.5 L of blood-stained fluid, enlarged friable spleen with rupture of the splenic capsule on the inner surface, and active bleeding. Splenectomy was performed. The patient was diagnosed with malarial spleen and received antimalarial therapy. CONCLUSIONS Splenic rupture with hemoperitoneum should be managed with laparotomy and splenectomy, along with antimalarial drugs. A high index of suspicion is needed to detect these complications early.
Collapse
Affiliation(s)
- Mohammad I. Fareed
- Department of General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ahmed E. Mahmoud
- Department of Anesthesia, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| |
Collapse
|
17
|
Ghosh S, Sengupta A, Sharma S, Sonawat HM. Metabolic perturbations of kidney and spleen in murine cerebral malaria: (1)H NMR-based metabolomic study. PLoS One 2013; 8:e73113. [PMID: 24039868 PMCID: PMC3765208 DOI: 10.1371/journal.pone.0073113] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 07/18/2013] [Indexed: 02/02/2023] Open
Abstract
A significant fraction of global population is under the threat of malaria. Majority of annual death is due to the more complicated form of the infection i.e. the cerebral form, also known as Cerebral Malaria (CM). Host parasite interaction is known to cause a cascade of events in various tissues like brain, liver, kidney, and spleen. We have employed (1)H NMR based metabolomics to understand the specific perturbations of various tissues in CM. In our previous paper we have delineated the differences between CM vis-a-vis non-cerebral malaria (NCM) mice in serum, liver and brain. In this paper we focus on their differences of metabolic profile in kidney and spleen as kidney dysfunction and splenomegaly are known to be associated to neurological outcome of the disease. Moreover we have also looked into how the biological compartments (kidney, spleen and serum) interact with each other. The various metabolites involved in such interactions and their correlational aspects across the compartments have been studied in CM, NCM and control mice. The idea was to find out the specific pathways that are altered in CM mice. Our results demonstrate that both the kidney as well as spleen metabolism are differentially perturbed in CM with respect to NCM. The results point out that glutamate levels are decreased in CM mice with respect to NCM mice both in case of spleen and kidney while creatine, myo-inositol and betaine levels are increased in kidney of CM mice with respect to NCM mice. From the analysis of Multiway Principal Component Analysis (MPCA) we see that lipid metabolism and TCA cycle is altered in kidney and spleen.
Collapse
Affiliation(s)
- Soumita Ghosh
- Department of Chemical Sciences, Tata Institute of Fundamental Research, Mumbai, India
| | - Arjun Sengupta
- Department of Chemical Sciences, Tata Institute of Fundamental Research, Mumbai, India
| | - Shobhona Sharma
- Department of Biological Sciences, Tata Institute of Fundamental Research, Mumbai, India
| | | |
Collapse
|
18
|
Seible DM, Khatana SAM, Solomon MP, Parr JB. Hoof beats may mean zebras: atraumatic splenic rupture. Am J Med 2013; 126:778-80. [PMID: 23830541 DOI: 10.1016/j.amjmed.2013.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 04/24/2013] [Accepted: 04/24/2013] [Indexed: 11/17/2022]
|
19
|
Abstract
Plasmodium falciparum malaria remains a major cause of mortality throughout the tropical world. Haematological abnormalities are considered a hallmark of malaria, bearing an impact on final outcome and representing indices of prognostic and follow-up value. These include severe anaemia, coagulation disturbances, leukocyte numerical or functional changes and spleen involvement. Anaemia involves red blood cell lysis due to parasite invasion, as well as mechanisms of intravascular haemolysis and decreased erythropoiesis. Exchange or blood transfusion is mainly recommended in the management of these patients. Haemorrhagic complications in severe malaria are relatively rare despite prominent thrombocytopenia and dysfunction in the coagulation pathway. Numerical, as well as functional changes in the white blood cell are less dramatic than other blood cell series, but still, remain a significant index of disease progression and ultimate prognosis. Finally, the role of the spleen in severe malaria is multifactorial. Care and vigilance should be taken against splenic rupture which is fatal and can occur despite appropriate antimalarial prophylaxis and treatment.
Collapse
|
20
|
Successful Nonoperative Management of Spontaneous Splenic Hematoma and Hemoperitoneum due to CMV Infection. Case Rep Gastrointest Med 2012; 2012:328474. [PMID: 23227374 PMCID: PMC3514804 DOI: 10.1155/2012/328474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 11/19/2012] [Indexed: 11/17/2022] Open
Abstract
Introduction. Spontaneous splenic hematoma or splenic rupture due to CMV infection in immunocompetent adults is rare and life-threatening. Case Report. Herein we report a rare case of spontaneous splenic hematoma and hemoperitoneum due to CMV infection in a 23-year-old Caucasian male in whom conservative management was successful. Conclusion. Spontaneous splenic hematoma and spontaneous splenic rupture are extremely rare conditions during primary CMV infection. Though rare, they must be always considered by the operating surgeon, because any misinterpretation may result in unfavorable outcomes.
Collapse
|
21
|
Aubrey-Bassler FK, Sowers N. 613 cases of splenic rupture without risk factors or previously diagnosed disease: a systematic review. BMC Emerg Med 2012; 12:11. [PMID: 22889306 PMCID: PMC3532171 DOI: 10.1186/1471-227x-12-11] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 07/28/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Rupture of the spleen in the absence of trauma or previously diagnosed disease is largely ignored in the emergency literature and is often not documented as such in journals from other fields. We have conducted a systematic review of the literature to highlight the surprisingly frequent occurrence of this phenomenon and to document the diversity of diseases that can present in this fashion. METHODS Systematic review of English and French language publications catalogued in Pubmed, Embase and CINAHL between 1950 and 2011. RESULTS We found 613 cases of splenic rupture meeting the criteria above, 327 of which occurred as the presenting complaint of an underlying disease and 112 of which occurred following a medical procedure. Rupture appeared to occur spontaneously in histologically normal (but not necessarily normal size) spleens in 35 cases and after minor trauma in 23 cases. Medications were implicated in 47 cases, a splenic or adjacent anatomical abnormality in 31 cases and pregnancy or its complications in 38 cases. The most common associated diseases were infectious (n = 143), haematologic (n = 84) and non-haematologic neoplasms (n = 48). Amyloidosis (n = 24), internal trauma such as cough or vomiting (n = 17) and rheumatologic diseases (n = 10) are less frequently reported. Colonoscopy (n = 87) was the procedure reported most frequently as a cause of rupture. The anatomic abnormalities associated with rupture include splenic cysts (n = 6), infarction (n = 6) and hamartomata (n = 5). Medications associated with rupture include anticoagulants (n = 21), thrombolytics (n = 13) and recombinant G-CSF (n = 10). Other causes or associations reported very infrequently include other endoscopy, pulmonary, cardiac or abdominal surgery, hysterectomy, peliosis, empyema, remote pancreato-renal transplant, thrombosed splenic vein, hemangiomata, pancreatic pseudocysts, splenic artery aneurysm, cholesterol embolism, splenic granuloma, congenital diaphragmatic hernia, rib exostosis, pancreatitis, Gaucher's disease, Wilson's disease, pheochromocytoma, afibrinogenemia and ruptured ectopic pregnancy. CONCLUSIONS Emergency physicians should be attuned to the fact that rupture of the spleen can occur in the absence of major trauma or previously diagnosed splenic disease. The occurrence of such a rupture is likely to be the manifesting complaint of an underlying disease. Furthermore, colonoscopy should be more widely documented as a cause of splenic rupture.
Collapse
Affiliation(s)
- F Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland, Health Sciences Centre, St. John’s, Newfoundland and Labrador, St Johns, Canada
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, St Johns, Canada
- Discipline of Family Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, St Johns, Canada
| | - Nicholas Sowers
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
22
|
El Khoury MY, Gandhi R, Dandache P, Lombardo G, Wormser GP. Non-surgical management of spontaneous splenic rupture due to Babesia microti infection. Ticks Tick Borne Dis 2011; 2:235-8. [PMID: 22108020 DOI: 10.1016/j.ttbdis.2011.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 06/20/2011] [Accepted: 08/04/2011] [Indexed: 10/17/2022]
Abstract
Babesiosis is an emerging tick-borne infection. We describe 2 hospitalized patients from the United States with spontaneous splenic rupture attributable to Babesia microti infection. The first patient was a 36-year-old previously healthy man with a low-grade splenic rupture not requiring surgical intervention. The second was a 70-year-old healthy man whose splenic rupture required proximal splenic artery embolization. Since the spleen is an important organ involved in controlling Babesia infection, management of splenic rupture in an infected patient using an organ preserving approach when appropriate may be preferred.
Collapse
Affiliation(s)
- Marc Y El Khoury
- Department of Medicine, Division of Infectious Diseases, New York Medical College, Valhalla, NY 10595, USA.
| | | | | | | | | |
Collapse
|
23
|
Asai K, Watanabe M, Matsukiyo H, Osawa A, Saito T, Hagiwara O, Nakamura Y, Okamoto Y, Saida Y, Kusachi S, Yokouchi Y, Nagao J. Pancreatic adenosquamous carcinoma presenting as splenic rupture: Report of a case. Surg Today 2011; 41:872-6. [DOI: 10.1007/s00595-010-4353-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 04/30/2010] [Indexed: 01/19/2023]
|
24
|
Abstract
Malaria remains a major cause of morbidity and mortality worldwide. The classic presentation of malaria with paroxysms of fever is seen only in 50%-70% of patients. Development of immunity, increasing resistance to antimalarial drugs, and indiscriminate use of antimalarial drugs have led to malaria presenting with unusual features. This review compiles a description of the various atypical manifestations of malaria.
Collapse
Affiliation(s)
- Syed Ahmed Zaki
- Department of Pediatrics, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India,
| | - Preeti Shanbag
- Department of Pediatrics, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, Maharashtra, India,
| |
Collapse
|
25
|
Kim EM, Cho HJ, Cho CR, Kwak YG, Kim MY, Cho YK. Abdominal computed tomography findings of malaria infection with Plasmodium vivax. Am J Trop Med Hyg 2011; 83:1202-5. [PMID: 21118922 DOI: 10.4269/ajtmh.2010.10-0160] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Abdominal computed tomography (CT) findings of malaria are not well-known even though malaria is a serious infectious disease. To identify abdominal CT findings, we selected 34 of 405 patients who had a positive peripheral blood smear for Plasmodium vivax and had underwent abdominal CT as the malaria group. We also selected 80 patients who had fever and a negative peripheral blood smear as the control group and 120 healthy people as the normal group. We reviewed and analyzed their medical records and CT findings retrospectively. The mean spleen and liver length were significantly larger in the malaria group and the incidence of splenomegaly, splenic focal low attenuation, and spontaneous splenic rupture were much higher in the malaria group (P < 0.05). Although abdominal CT is not an indispensable tool for diagnosis, these CT findings will help in the diagnosis of malaria in patients with fever.
Collapse
Affiliation(s)
- Eun Mi Kim
- Department of Radiology, Inje University Ilsan-Paik Hospital, Goyang, Gyeonggi, South Korea
| | | | | | | | | | | |
Collapse
|
26
|
Rice JP, Sutter CM. Spontaneous splenic rupture in an active duty Marine upon return from Iraq: a case report. J Med Case Rep 2010; 4:353. [PMID: 21054871 PMCID: PMC2992067 DOI: 10.1186/1752-1947-4-353] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 11/05/2010] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Atraumatic splenic rupture is a rare event that has been associated with several infectious disease processes. In the active duty military population, potential exposure to these pathogens is significant. Here we discuss the case of an active duty Marine with spontaneous splenic rupture upon return from a six-month deployment in Iraq. CASE PRESENTATION A previously healthy 30-year-old Caucasian male active duty Marine presented with abdominal pain, fever and diarrhea after deployment to Iraq in support of Operation Iraqi Freedom. Based on clinical and radiographic evidence, a diagnosis of spontaneous splenic rupture was ultimately suspected. After exploratory laparotomy with confirmation of rupture, splenectomy was performed, and the patient made a full, uneventful recovery. Histopathologic examination revealed mild splenomegaly with a ruptured capsule of undetermined cause. CONCLUSION Spontaneous splenic rupture is a rare event that may lead to life-threatening hemorrhage if not diagnosed and treated quickly. Although the cause of this patient's case was unknown, atraumatic splenic rupture has been associated with a variety of infectious diseases and demonstrates some risks the active duty military population may face while on deployment. Having an awareness of these pathogens and their role in splenic rupture, clinicians caring for military personnel must be prepared to recognize and treat this potentially fatal complication.
Collapse
Affiliation(s)
- Jason P Rice
- Branch Medical Clinic, Marine Corps Air Station Miramar, 19871 Mitscher Way, San Diego, CA 92145, USA.
| | | |
Collapse
|
27
|
Peera MA, Lang ES. Delayed diagnosis of splenic rupture following minor trauma: beware of comorbid conditions. CAN J EMERG MED 2010; 6:217-9. [PMID: 17433170 DOI: 10.1017/s1481803500006874] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Although rare, spontaneous splenic rupture has been reported in cases of chronic lymphocytic leukemia (CLL). In contrast, there are no published reports of splenic injury resulting from minor trauma in CLL patients. We report the case of an 81-year-old woman with a history of CLL, who presented with minor trauma to her coccygeal region, and was found to have a splenic rupture. We briefly describe the incidence, pathogenesis, presentation, diagnosis, management and prognosis of splenic injury, especially in cases with a history of splenomegaly.
Collapse
|
28
|
Thapa R, Ghosh A, Banerjee T. Childhood Plasmodium falciparum malaria complicated by splenic abscess. Emerg Med Australas 2009; 21:237-9. [PMID: 19527285 DOI: 10.1111/j.1742-6723.2009.01188.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report on an 8-year-old girl with Plasmodium falciparum malaria complicated by splenic abscess during the course of her infection. The diagnosis of malaria was based upon the demonstration of trophozoites of P. falciparum in the peripheral blood smear. The trophozoites of the same organism were visualized on the Giemsa-stained smear prepared from the percutaneous splenic aspirate specimen. The patient failed to respond to parenteral Artesunate alone, which demanded emergent splenectomy. To our knowledge, this is the first report of splenic abscess complicating the course of childhood P. falciparum malaria in the English literature.
Collapse
Affiliation(s)
- Rajoo Thapa
- Department of Pediatrics, Institute of Child Health, West Bengal, India.
| | | | | |
Collapse
|
29
|
Gedik E, Girgin S, Aldemir M, Keles C, Tuncer MC, Aktas A. Non-traumatic splenic rupture: Report of seven cases and review of the literature. World J Gastroenterol 2008; 14:6711-6. [PMID: 19034976 PMCID: PMC2773315 DOI: 10.3748/wjg.14.6711] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate seven patients with non-traumatic splenic rupture (NSR). NSR is an uncommon dramatic abdominal emergency that requires immediate diagnosis and prompt surgical treatment to ensure the patient’s survival.
METHODS: Within 11 years, seven cases were evaluated for patient characteristics, anamnesis and symptoms, method of diagnosis, findings of laparotomy, and etiology of NSR.
RESULTS: There were six (86%) male and one female (14%) patient, whose mean age was 36 ± 12.8 (17-56) years. We report here four cases of Plasmodium vivax malaria (cases I-IV), one case of hemodialysis (case V), one case of spontaneous splenic rupture (case VI), and one case of hairy cell leukemia (case VII). Splenectomy was performed in all patients. All of them made an uneventful recovery and were discharged in stable condition.
CONCLUSION: NSR is a rare entity that needs a high index of suspicion for diagnosis. Using ultrasonography or computer tomography, and peritoneal aspiration of fresh blood may assist in the diagnosis of NSR. Increased awareness of NSR can enhance early diagnosis and effective treatment.
Collapse
|
30
|
López-Tomassetti Fernández EM, Delgado Plasencia L, Arteaga González IJ, Carrillo Pallares A, Hernández Siverio N. [Atraumatic rupture of the spleen: experience of 10 cases]. GASTROENTEROLOGIA Y HEPATOLOGIA 2008; 30:585-91. [PMID: 18028854 DOI: 10.1157/13112586] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The most common cause of splenic rupture is trauma. Less frequently the spleen ruptures due to an ongoing hematologic, infectious or tumoral disease (pathologic rupture). We present a series of 10 patients with atraumatic splenic rupture: in seven patients there was a pathologic rupture. Two of the remaining three patients with spontaneous rupture were morbidly obese; this association has not previously been reported. The present review discusses the etiology, pathogenesis and optimal treatment of this entity.
Collapse
|
31
|
Abouzahir A, Bouchama R. Rupture spontanée de la rate au cours du paludisme. Med Mal Infect 2008; 38:153-5. [DOI: 10.1016/j.medmal.2007.10.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Accepted: 10/07/2007] [Indexed: 10/22/2022]
|
32
|
Amathieu R, Tual L, Rouaghe S, Stirnemann J, Fain O, Dhonneur G. Rupture spontanée de la rate au cours d'une infection à cytomégalovirus: cas clinique et revue de la littérature. ACTA ACUST UNITED AC 2007; 26:674-6. [DOI: 10.1016/j.annfar.2007.03.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2006] [Accepted: 03/01/2007] [Indexed: 11/30/2022]
|
33
|
Jiménez BC, Navarro M, Huerga H, López-Vélez R. Spontaneous splenic rupture due to Plasmodium vivax in a traveler: case report and review. J Travel Med 2007; 14:188-91. [PMID: 17437476 DOI: 10.1111/j.1708-8305.2007.00112.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Beatriz C Jiménez
- Tropical Medicine and Clinical Parasitology, Infectious Diseases Department, Hospital Ramón y Cajal, Madrid, Spain
| | | | | | | |
Collapse
|
34
|
Sterlacci W, Heiss S, Augustin F, Tzankov A. Splenic Rupture, Beyond and Behind: A Histological, Morphometric and Follow-Up Study of 254 Cases. Pathobiology 2007; 73:280-7. [PMID: 17374965 DOI: 10.1159/000099122] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 11/28/2006] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Population-based data regarding splenic rupture causes are sparse. To systematically characterize histology and morphometry of splenic rupture, we performed a retrospective clinicopathological study of 254 patients. METHODS Our electronic data base was reviewed and all splenic rupture cases were morphologically, morphometrically and, where needed, molecularly analyzed. Clinical and follow-up data were gained by reviewing patient charts. A formula to calculate splenic volume based on size was established and results were compared to the actual volumes. RESULTS Ruptured spleens presented 0.1% of all gross surgical pathology specimens. Nearly 90% were due to trauma and approximately 10% were pathologic, being associated with underlying diseases (5% with unexpected diseases) such as splenic angiomas, granulomatous diseases, infarctions, hepatopathies, cysts, hemorrhagic diatheses, hematological neoplasms, metastatic carcinoma and collagenosis. Men were more often affected than women. Morphometric analysis showed distinct splenic weights, volumes and capsule thicknesses with respect to the different rupture causes. Pathological ruptures were predominantly observed in elderly, male patients with larger spleens. CONCLUSIONS Splenic rupture is due to an often unexpected underlying disease in approximately 10% of the cases. This should be kept in mind when dealing with susceptible patient groups.
Collapse
Affiliation(s)
- William Sterlacci
- Institute of Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | | | | | | |
Collapse
|
35
|
Restrepo CS, Raut AA, Riascos R, Martinez S, Carrillo J, Prasad SR. Imaging Manifestations of Tropical Parasitic Infections. Semin Roentgenol 2007; 42:37-48. [PMID: 17174173 DOI: 10.1053/j.ro.2006.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Carlos S Restrepo
- Radiology Department, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
| | | | | | | | | | | |
Collapse
|
36
|
Abstract
Malaria is one of the most frequent causes of fever among travellers to tropical countries. We report the CT imaging findings of poor contrast enhancement of the spleen on arterial phase in a case of malaria presenting as splenomegaly. To the best of our knowledge, this is the first report of malarial spleen diagnosed by these CT results.
Collapse
Affiliation(s)
- K Bae
- Department of Diagnostic Radiology, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | | |
Collapse
|
37
|
Karasakalides A, Ganas E, Triantafillidou S, Lagonidis D, Papapavlou L, Nakos G. Spontaneous rupture of a true splenic cyst diagnosed by laparoscopy. Dig Dis Sci 2006; 51:1829-32. [PMID: 16964545 DOI: 10.1007/s10620-006-9076-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Accepted: 09/26/2005] [Indexed: 12/09/2022]
Affiliation(s)
- A Karasakalides
- Department of Surgery/ICU, Giannitsa General Hospital, Terma Semertzidis, Giannitsa 58100, Greece.
| | | | | | | | | | | |
Collapse
|
38
|
|
39
|
Arshad M, Seiter K, Bilaniuk J, Qureshi A, Patil A, Ramaswamy G, Liu D. Side Effects Related to Cancer Treatment. J Clin Oncol 2005; 23:8533-4. [PMID: 16293882 DOI: 10.1200/jco.2005.04.1012] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Muhammad Arshad
- Department of Medicine, New York Medical College, Valhalla, NY, USA
| | | | | | | | | | | | | |
Collapse
|
40
|
Tataria M, Dicker RA, Melcher M, Spain DA, Brundage SI. Spontaneous Splenic Rupture: The Masquerade of Minor Trauma. ACTA ACUST UNITED AC 2005; 59:1228-30. [PMID: 16385305 DOI: 10.1097/01.ta.0000196439.77828.9d] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Monika Tataria
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Stanford University Medical Center, Stanford, California 94305, USA
| | | | | | | | | |
Collapse
|
41
|
Jacobs FM, Prat D, Petit F, Smadja C, Brivet FG. Spontaneous Rupture of the Spleen during Malaria: A Conservative Treatment Approach May Be Appropriate. Clin Infect Dis 2005; 40:1858-9. [PMID: 15909278 DOI: 10.1086/430446] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
42
|
Ozsoy MF, Oncul O, Pekkafali Z, Pahsa A, Yenen OS. Splenic complications in malaria: report of two cases from Turkey. J Med Microbiol 2004; 53:1255-1258. [PMID: 15585506 DOI: 10.1099/jmm.0.05428-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Malaria is still a major health problem in Turkey, where Plasmodium vivax malaria is endemic. Spontaneous rupture of the spleen is an important and life-threatening complication and occurs in up to an estimated 2 % of cases. Hence the small number of case reports suggests under-reporting or underdiagnosis. Review articles have reported only 18 malaria cases with spontaneous splenic rupture in the English language literature since 1960. Two cases of P. vivax malaria with splenic complications are reported here. One of them showed signs and symptoms of acute abdominal pain, then splenic rupture occurred.
Collapse
Affiliation(s)
- M F Ozsoy
- Departments of Infectious Diseases1 and Radiodiagnostic Radiology2, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey
| | - O Oncul
- Departments of Infectious Diseases1 and Radiodiagnostic Radiology2, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey
| | - Z Pekkafali
- Departments of Infectious Diseases1 and Radiodiagnostic Radiology2, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey
| | - A Pahsa
- Departments of Infectious Diseases1 and Radiodiagnostic Radiology2, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey
| | - O S Yenen
- Departments of Infectious Diseases1 and Radiodiagnostic Radiology2, Gulhane Military Medical Academy, Haydarpasa Training Hospital, Istanbul, Turkey
| |
Collapse
|
43
|
Abstract
The management of any surgical condition in a haemophilia patient is a challenging problem for the surgeon. It is particularly difficult if the patient presents in extremis, with no apparent cause for their collapse. We report a case of successful management of spontaneous splenic rupture in a severe haemophiliac, and review the literature associated with this unusual condition.
Collapse
|
44
|
Richter J, de Bernardis C, Sagir A, Walter S, Savalli E, Häussinger D. Is ultrasound a useful adjunct for assessing malaria patients? Parasitol Res 2004; 94:349-53. [PMID: 15549382 DOI: 10.1007/s00436-004-1208-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2004] [Accepted: 06/08/2004] [Indexed: 12/17/2022]
Abstract
The value of ultrasonography as an adjunct for diagnosis and monitoring malaria was investigated. In all, 118 patients (male/female 65/53; age 2-78 years, median 29 years) with malaria underwent a standardised abdominal ultrasound examination at baseline. In 62 out of 118 patients, ultrasonography was repeated 21 days later. In the results at baseline, huge splenomegaly with firm organ consistency, consistent with hyperreactive malarious splenomegaly syndrome, was observed in two Cameroonese children. In the other 116 patients, the most common finding was non-specific splenomegaly (96/116, 82.76%), occurring more frequently in non-immune patients (71/78, 91.03%) than in patients who had grown up in malaria-endemic areas (25/38, 65.79%; P<0.002). No correlation was found between liver or spleen size and any clinical parameter. The results on day 21 show that, although splenomegaly after therapy persisted more frequently in patients with malaria recrudescence or relapse (8/8, 100%) than in patients cured (32/54, 59.26%; P<0.0421), the practical value of this finding is questionable. Ultrasonography cannot be regarded as a first-line diagnostic method in patients with malaria.
Collapse
Affiliation(s)
- Joachim Richter
- Tropical Medicine Unit, Clinic for Gastroenterology, Hepatology and Infectious Diseases, Heinrich-Heine-University, 40225 Duesseldorf, Germany.
| | | | | | | | | | | |
Collapse
|
45
|
Kianmanesh R, Aguirre HI, Enjaume F, Valverde A, Brugière O, Vacher B, Bleichner G. [Spontaneous splenic rupture: report of three new cases and review of the literature]. ANNALES DE CHIRURGIE 2003; 128:303-9. [PMID: 12878066 DOI: 10.1016/s0003-3944(03)00092-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study reports 3 new cases of spontaneous (or atraumatic) splenic rupture of the spleen, including two with massive hemoperitoneum and one with a secondary rupture of splenic infarct, and reviews the literature about this rare disease. These spontaneous ruptures are rare and potentially fatal. They result from infectious diseases (mainly mononucleosis and and paludism) and hematological diseases (mainly malignant hemopathies) in more than 50% of cases. Mortality is close to 20%, and includes some deaths occurring before diagnosis was established and postoperatives deaths, which can result from delayed management and bad general condition of the patients. Splenectomy is usually mandatory. Non-surgical treatment can be indicated only in young and stable patients.
Collapse
Affiliation(s)
- R Kianmanesh
- Service de chirurgie digestive, hôpital Beaujon (AP-HP), Clichy, 100, boulevard du Général-Leclerc, 92118 cedex, Clichy, France
| | | | | | | | | | | | | |
Collapse
|
46
|
Ribordy V, Schaller MD, Martinet O, Doenz F, Liaudet L. Spontaneous rupture of the spleen during malaria treated with transcatheter coil embolization of the splenic artery. Intensive Care Med 2002; 28:996. [PMID: 12349822 DOI: 10.1007/s00134-002-1309-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
47
|
Hamel CT, Blum J, Harder F, Kocher T. Nonoperative treatment of splenic rupture in malaria tropica: review of literature and case report. Acta Trop 2002; 82:1-5. [PMID: 11904097 DOI: 10.1016/s0001-706x(02)00025-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In many parts of the world malaria still is a major medical problem. Heavy international and transcontinental traveling carries malaria to non-endemic areas. Practicing physicians must be aware of the common, but also the rare and severe complications of malaria. During malaria changes in splenic structure can result in asymptomatic enlargement or complications such as hematoma formation, rupture, hypersplenism, ectopic spleen, torsion, or cyst formation. An abnormal immunological response may result in massive splenic enlargement. Spontaneous rupture of the spleen is an important and life threatening complication of Plasmodium vivax infection, but is rarely seen in Plasmodium falciparum malaria. The ability to properly diagnose and manage these complications is important. Spleen-conserving procedures should be the standard whenever possible especially in patients with a high likelihood of future exposure to malaria.
Collapse
Affiliation(s)
- Christian T Hamel
- Department of Surgery, University Hospital of Basel, General Surgical Service, Spitalstrasse 21, 4031, Basel, Switzerland.
| | | | | | | |
Collapse
|