Splenic rupture following colonoscopy

Colonoscopy is a safe and routinely performed diagnostic and therapeutic procedure for different colorectal diseases. Although the most common complications are bleeding and perforation, extracolonic or visceral injuries have also been described. Splenic rupture is a rare complication following colonoscopy, with few cases reported. We report a 60-year-old female who presented to surgical consultation 8 h after a diagnostic colonoscopy. Clinical, laboratory and imaging findings were suggestive for a massive hemoperitoneum. At surgery, an almost complete splenic disruption was evident, and an urgent splenectomy was performed. After an uneventful postoperative period, she was discharged home. Splenic injury following colonoscopy is considered infrequent. Direct trauma and excessive traction of the splenocolic ligament can explain the occurrence of this complication. Many times the diagnosis is delayed because the symptoms are due to colonic insufflation, so the most frequent treatment is an urgent splenectomy. A high index of suspicion needs an early diagnosis and adequate therapy.     

脾切除对脂质代谢影响的实验研究

目的 探讨脾切除对脂质代谢的影响,以及保留部分和自体脾移植是否对脂质代谢产生有益的作用。方法 将３５只大鼠随机均分为普通饮食组（ＯＦ）、高胆固醇饮食组（ＡＣＦ）、脾切除＋高胆固醇饮食组（ＳＴ）、部分脾切除＋高胆固醇饮食组（ＨＳＴ）、脾切除＋自体脾移植＋高胆固醇饮食组（ＳＴＳＡ）。观察血脂变化。结果 ＡＣＦ组血清甘油三酯（ＴＧ）,胆固醇（ＣＨＯＬ）呈升高趋势。ＳＴ组血清ＴＧ,ＣＨＯＬ进一步升高,高密     

脾切除430例临床分析

目的 分析总结脾切除手术的近期疗效以提高其安全性、降低死亡率,减少并发症并指导正确掌握切脾适应证。方法 统计４３０例脾切除手术病人的临床资料,包括切脾指征、手术种类、术后并发症和手术死亡率。结果 切脾指征中原发疾病以肝脏为最多,占１９２例（４４．６５％）,尤其是门脉高压性脾亢１６４例（３８．１５％）;４３０例病人共行７６８例次不同类型的手术,除切脾外,以分流断流为最多,共７５例次（２３．６６％）;     

充血性脾大伴脾功能亢进患者不同脾切除术前后血小板相关抗体的变化

目的 了解充血性脾肿大伴脾功能亢进（脾亢）患者血小板相关抗体（ＰＡ－ＩｇＧ）水平及不同脾切除术后的改变,探索脾肿大、血小板、ＰＡ－ＩｇＧ之间的关系。方法 采用竞争性酶联免疫吸附试验（ＥＬＩＳＡ）检测了２４例脾肿大伴脾亢患者血清ＰＡ－ＩｇＧ水平。结果 脾肿大伴脾亢患者的ＰＡ－ＩｇＧ水平明显高于正常者（Ｐ〈０．０１）,而血小板值低,ＰＡ－ＩｇＧ与血小板之间存在显著负相关（ｒ＝－０．４７４７,Ｐ〈０．０     

Prevention and management of infections in patients without a spleen

Patients who lack a functioning spleen become vulnerable to sepsis caused by bacteria and, occasionally, protozoa. The risk is higher in children and in those who have had immunosuppressive treatment, and the risk remains lifelong. Overwhelming post-splenectomy infection (OPSI) occurs at an estimated incidence of 0.23–0.42% per year, with a lifetime risk of 5%. Episodes of OPSI are emergencies, requiring immediate parental antibiotics and intensive care; intravenous immunoglobulins may be useful. OPSI carries a mortality of 38–69%. Streptococcus pneumoniae is the commonest infecting organism, accounting for 50–90% of isolates from blood cultures in reported series; it is particularly common in children with sickle cell disease. Less commonly, the infecting organisms are other bacteria, Babesia or Ehrlichia . OPSI may be, to some extent, preventable by several interventions. These are surgical conservation of the spleen; immunization against S. pneumoniae , Haemophilus influenzae type b, and Neisseria meningitidis ; prophylactic antibiotics; stand-by antibiotics; patient information sheets; and a medical alert bracelet. Asplenic patients living in malaria-endemic areas require optimal prophylaxis. The initial step in prevention of OPSI is the creation of an asplenia register, as many patients are not covered by these simple measures.     

Impact of Splenectomy for Lymph Node Dissection on Long-Term Surgical Outcome in Gastric Cancer

Background:In the treatment of gastric cancer, splenectomy is performed for effective lymph node dissection around the splenic artery and splenic hilum. The purpose of this study was to clarify the long-term outcome of splenectomy in the treatment of gastric cancer.Methods: The effect of splenectomy on recurrence and prognosis was examined in a retrospective analysis of 665 patients who had undergone curative total gastrectomy for gastric carcinoma from 1987 to 1996. The risk factors associated with recurrence and prognosis were investigated by univariate and multivariate analysis.Results: The splenectomy group showed more advanced lesions and a higher recurrence rate than the spleen-preserved group. However, after adjusting for the TNM (tumor, node, metastasis) stage, there was no significant difference in recurrence rate and pattern between the two groups. Logistic regression analysis revealed that gross type, serosal invasion, and nodal metastasis were independent risk factors for recurrence while splenectomy was not. When comparing patients with the same TNM (tumor, node, metastasis) stages, no significant difference in the 5-year survival rates was apparent. Multivariate analysis demonstrated that age, serosal invasion, and nodal metastasis were independent prognostic factors whereas splenectomy was not.Conclusions: These data suggest that splenectomy for lymph node dissection in gastric cancer is not effective regarding long-term patient prognosis.     

脾切除对不明原因发热伴脾肿大病人的临床意义

目的探讨不明原因发热伴脾肿大时行脾切除术的临床意义及围手术期处理方法。方法回顾性分析我院1990年1月~2005年12月收治的不明原因发热伴脾肿大病人43例的临床资料。本组病例均行脾切除术,并取肝组织及腹腔淋巴结活检,以明确病理诊断。结果本组43例中,最终明确诊断者40例,占93.0%。其中,以血液系统恶性疾病最多见,占60.6%。大部分病人术后均接受了正规化疗,病情缓解。术后并发症发生率为25.6%,以感染最为常见。脾切除术后1月内死亡2例。结论对于不能明确诊断的发热伴脾肿大的病人,脾切除术具有十分重要的临床意义,应尽早施行。     

延迟性脾破裂24例诊治分析

目的探讨延迟性脾破裂的发病机理及其诊治方法。方法回顾性分析我们于1996年1月~2005年12月收治的延迟性脾破裂24例的临床资料。全部病例均行脾切除手术治疗。其中,有2例儿童病人术中加行自体脾组织网膜内移植术。结果全组病人均治愈。平均住院日为13d。结论延迟性脾破裂时病人机体本身自限作用已降低,应首选手术治疗。提高对本病的认识、及时诊断可降低其发生率。     

腹腔镜与开腹脾切除术在脾淋巴瘤治疗中的对比研究

目的:探讨腹腔镜脾切除术(LS)与开腹脾切除术(OS)治疗原发性脾脏淋巴瘤(PSL)的临床疗效.方法:回顾分析2012年9月至2018年1月手术治疗的35例PSL患者的临床资料,其中18例行OS(开腹组),17例行LS(腹腔镜组,包括手助式).对比分析两组手术时间、术中出血量、术后镇痛时间、术后下床活动时间、术后通气时...     

Non-traumatic rupture of voluminous non-typhoid Salmonella splenic abscess presenting with peritonitis: Case report and review of the literature

Introduction and importanceSplenic abscess (SA) is an uncommon, life-threatening disease with about 600 reported cases in the literature. It is caused by various infective pathogens and generally occurs in immunocompromised patients. SA is a rare complication of non-typhoid Salmonella (NTS) infection. Diagnosis of ruptured SA is a challenge because the absence of specific symptoms and signs. Abdominal computed tomography (CT) scan represents the gold standard in diagnosing of SA. Splenectomy is the treatment of choice of ruptured SA with peritonitis.Case presentationA 26-year-old Caucasian female was admitted to the Emergency Department with a three-day history of abdominal pain and fever. Physical examination revealed severe and generalized abdominal pain on superficial and deep palpation with obvious muscle guarding and rebound tenderness. Abdominal CT scan showed ruptured SA. Laboratory tests reported anemia (hemoglobin 10.4 g/dl). The patient was taken emergently to the operating room for splenectomy. The postoperative course was uneventful, the patient was discharged on the 7th post-operative day. Diagnosis of NTS SA was made by pus cultures.Clinical discussionSA is a rare complication of NTS infection associated with high morbidity and mortality rates. Although different types of treatment of SA are reported in the literature, splenectomy represents the treatment of choice of ruptured SA.ConclusionNTS SA is difficult to diagnose because of its rarity and non-specific clinical presentation, often fatal if left untreated. Although there is no gold standard for treating SA, splenectomy with peritoneal lavage is mandatory in case of ruptured SA with peritonitis.