Patient with puzzling splenic rupture

Patient with puzzling splenic rupture

23/11/2014

A 61-year-old Japanese has visited a hospital in Tokyo after three weeks of fatigue and a slight fever, apparently just in time. For in the examination the physicians immediately noticed the greatly enlarged spleen of the man. Nevertheless, the doctors around Kensuke Adachi of the Tokyo Metropolitan Tama Medical Center were initially unable to make an accurate diagnosis.

The causes of such enlargement can be diverse in nature, ranging from infectious diseases to spleen cancer. Such a causative cancer (lymphoid cancer, sarcoma, cancers with metastasis) causes quite noticeable symptoms. For example, malignant lymphomas may be associated with lymphadenopathy, chronic fatigue, loss of appetite, night sweats, and generally increased susceptibility to infection. However, none of these symptoms provides a reliable indicator because they can also be associated with many other disorders. "As the disease progresses, sufferers often suffer from discomfort caused by pressure on the surrounding tissues and organs due to the tumorous enlargement of the spleen, including abdominal pain, abdominal pressure, nausea, or radiating pain in the abdomen the left shoulder come. "

However, the man also did not benefit from laboratory tests and a CT, in addition to confirming that the spleen is greatly enlarged, did not provide any new findings, such as an examination of the bone marrow, lung and mucous membrane.

Pain shortly after the CT
However, shortly after the examination, the patient began to cough and complained of abdominal pain and left shoulder pain. In addition, his circulation collapsed and the hemoglobin level in the blood dropped significantly, so he was re-examined on CT. The treating physicians discovered a splenic rupture, which explained the pain in the left shoulder and made emergency surgery mandatory. During the operation, the spleen of the man was then completely removed and three liters of blood were taken from the abdominal cavity.

In principle, however, such an intervention also poses dangers: the affected persons may then continue to live without spleen, but they are subject to certain risks, such as an increased susceptibility to infection by certain bacteria, which can cause pneumonia, meningitis, middle ear infections and inflammation of the paranasal sinuses. Furthermore, after a so-called splenectomy increases the risk of thrombosis. Nonetheless, splenectomy is a standard procedure designed to maximize the reduction of tumor tissue, thereby increasing the chances of successful treatment.

As it turned out, the procedure was urgently needed in the case of the Japanese, because the distant organ of the man was almost twice as large as normal and in a pathological examination, the doctors found a so-called non-Hodgkin's lymphoma, a cancer. Further tests confirmed the diagnosis.

After two months of regeneration, chemotherapy and vaccination, as well as extensive antibiotics, the man's blood levels are now back to normal. He no longer has lymphoma and is not infected with an infectious disease. (Sb)