Splenic artery rupture in pancreatic pseudocyst

Hemorrhage is one of the most threatening complication of pancreatic pseudocyst. It results from erosion of adjacent vessels. Splenic, gastroduodenal, pancreaticoduodenal and middle colic vessels are predominantly involved. Hemorrhage may present different feature: intra and/or extraperitoneal collection, gastrointestinal bleeding. The authors report the rupture of splenic artery into pseudocyst, with the formation of pulsating pseudoaneurysm, increasing progressively until the final rupture. For the diagnosis the authors utilized: ultrasounds (US) which showed the cyst but not its nature and content; the CT scan which disclosed haematic contents; finally the US Color Doppler which proved the dynamic feature of hemorrhage. This technique allows to identify the arterious or venous source of bleeding and the possible presence of arteriovenous fistula. Arteriography was not performed due to circumstances, although it would permit bleeding vessel embolization and the control of hemorrhage. This procedure is not ever achievable, and doesn't exclude the possibility of rebleeding. On surgery, since the intraoperative rupture of the pseudoaneurysm occurred with severe hypovolemic shock, only a timely posterior mesogastric mobilization and the medially displacement of spleen-body-tail pancreatic complex, allowed to clamp the mass and the hemostasis. When such lesion are approached, it is mandatory to be prepared to carry on this maneuver: the severity of bleeding cannot allow intracystic ligature of bleeding vessel.     

Splenic regeneration following splenectomy for traumatic rupture

Thirty-three patients previously splenectomized following traumatic rupture of the spleen were assessed using a radionuclide technique. Splenic tissue was detected by this means in 22 patients (67%). Peripheral venous blood was examined for the presence of erythrocyte surface vacuoles. Vacuolated red blood cells were detected more frequently than in the normal population. The incidence of vacuolated red blood cells was inversely related to the estimated volume of regenerated splenic tissue.     

Splenic abscess after lithotripsy of pancreatic duct stones.

We describe a case of splenic abscess following lithotripsy of pancreatic stones, for which emergency splenectomy eventually had to be performed. It is important to be aware of this complication, because splenic abscess is still a life-threatening entity.     

Splenic abscess following nonoperative management of splenic rupture

A recent case of posttraumatic splenic abscess in a young man following nonoperative management of his splenic rupture is reported. With the recent trend toward nonoperative management of hemodynamically stable splenic rupture, the potential complications of splenic abscess may become more common. In view of the high mortality associated with unrecognized splenic abscess, it is important for the clinician to be aware of this entity.     

Splenic rupture after colonoscopy.

Colonoscopy is a familiar and well-tolerated procedure and is widely used as a diagnostic and therapeutic modality by both gastroenterologists and surgeons. Although perforation and hemorrhage are the most common complications, splenic injury or rupture is a rare but potentially lethal complication. We report a case of splenic rupture diagnosed 18 hours after colonoscopy, which required emergent splenectomy. We also reviewed over 39 other cases of splenic rupture or injury after colonoscopy reported in the English literature. Despite being an infrequent complication, splenic rupture warrants a high degree of clinical suspicion critical to prompt diagnosis. Most patients present with symptoms within 24 hours after colonoscopy, although delayed presentation days later has been described. CT scan of the abdomen is the radiological study of choice to evaluate colonoscopic complications. Splenic injury can be managed conservatively or with arterial embolization depending on the extent of trauma, but splenectomy remains definitive management. Clinical criteria are the primary determinants in choosing operative therapy over observation. Herein, possible risk factors for splenic trauma during colonoscopy are identified, and clinical outcomes are evaluated.     

Splenic rupture in a newborn

Traumatic rupture of the spleen in the newborn is a rare event and is seldom reported in the literature. It can occur to an abnormally enlarged spleen or to a normal spleen. In the latter, it usually is associated with difficult delivery. Previously, the majority of patients died probably because of delayed or missed diagnoses. The classic presentation is a triad of bleeding, abdominal distension, and hemoperitoneum. High index of suspicion and improvement in diagnostic tools like ultrasonography and computed tomography are important contribuations in early diagnosis so that appropriate treatment can be implemented. Splenectomy is no longer the standard treatment because it increases the chance of postsplenectomy sepsis. Instead, treatment should aim for hemostasis and preservation of spleen. The authors present a case of traumatic rupture of spleen in a normal newborn with normal labor and delivery. The first symptom began at 16 hours of age and evolved to a full-blown classic picture. The baby was saved without splenectomy, and the recovery was smooth and uneventful. This is probably the first reported case of a patient treated without splenectomy in this locality. Discussion of the condition and review of the literature also are presented.     

Intraoperative removal of pancreatic duct calculus with a rigid ureterorenoscope and ultrasonic lithotripsy

A 51-year-old man with chronic relapsing pancreatitis and recurrent episodes of acute attacks had an impacted ductal stone deep in the head of the pancreas. A staghorn calculus, 1 cm in diameter, was successfully disintegrated and removed intraoperatively with use of a visual endourologic technique and ultrasonic lithotripsy. Because of a dilated pancreatic duct and pseudocyst formation near the tail of the pancreas, distal pancreatic resection and longitudinal pancreaticojejunostomy were performed. Postoperatively, no pancreas irritation has been verified, and the patient has remained without symptoms.     

Intrahepatic bile duct rupture following blunt abdominal trauma

The natural history of intrahepatic bile duct rupture secondary to blunt trauma is not known. A unique case of bilateral hepatic lobar duct rupture is presented to demonstrate the clinical features and potential complications of this injury. Operative intervention is not always indicated and treatment should be dictated by the specific lesion.     

肝胆管结石的内镜治疗

目的探讨纤维胆道镜、十二指肠镜治疗肝胆管残留结石的疗效. 方法回顾分析1985年2月～2004年6月纤维胆道镜治疗573例,十二指肠镜治疗36例的临床资料. 结果经T管窦道用纤维胆道镜取石,取净率96.02%(507/528);经皮经肝纤维胆道镜置镜成功率84.21%(16/19),结石取净率78.95%(15/19);经皮下盲袢纤维胆道镜取石取净率84.62%(22/26).经十二指肠镜胆道造影成功率91.67%(33/36),结石取净率80.56%(29/36). 结论纤维胆道镜、十二指肠镜治疗肝内胆管残留结石和复发结石有效、便捷.     

胆管结石的腹腔镜手术治疗

目的 探讨腹腔镜结合胆道镜治疗胆管结石的可行性。方法 1997年7月—2000年12月，100例肝外或肝内外并存胆管结石，采用腹腔镜下胆总管切开取石后置T管，或术中、术后胆道镜取石。结果 100例肝内外胆管结石在术中取净42例，术后1次—6次完全取净58例，随访3年无结石残留。结论 腹腔镜结合胆道镜是治疗胆管结石的有效方法。