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Post Splenectomy Fatal Pulmonary Embolism in a Patient with Moderate Hemophilia A
Abdolhossein Davoodabadi,Mohammad Mahdi Adib,Behrooz Keleidar
Iranian Journal of Medical Sciences , 2011,
Abstract: Hemophilia A is a bleeding disorder caused by defective production of factor VIII. The main concern associated with the disease is bleeding, especially after trauma and surgeries. Factor VIII replacement therapy is associated with substantial decrease of bleeding events during surgery. However, there have been a number of reports of thromboemblic events in this situation. The present report describes a case of moderate hemophilia A in which splenectomy did lead to pulmonary embolism and subsequent death. The patient was a 25-year-old man with hemophilia A admitted after a car accident and trauma to left lower chest and abdomen. He received factor VIII concentrates for replacement therapy. He was hemodynamically stable on the first day, but on the second day his hemoglobin declined and he showed signs of abdominal tenderness. He, therefore, was subjected to laparatomy and splenectomy. After the operation, he suddenly developed dyspnea and decline in blood pressure, and death afterwards. Autopsy of the patient revealed massive pulmonary thromboembolism. The symptoms and outcome of the present case indicate that although pulmonary thromboembolism in the early postoperative period in patients with hemophilia A undergoing splenectomy and receiving factor VIII concentrate for replacement is rare, it should not be assumed a far-fetched event, and prophylactic measures to prevent thromboemboly must be considered.
SPLENECTOMY
AHMED KHAN CHAUDHRY
The Professional Medical Journal , 2004,
Abstract: Objective: To assess the role of splenectomy in patients ofidiopathic thrombocytopenic purpura. Design: It is a retrospective study. Place and Duration: This study wasconducted at PNS Shifa Karachi, Combined Military Hospital Lahore and Military Hospital Rawalpindispanning over last 10 years from 1993-2003. Subjects and methods: A total of 17 patients were included inthe study, which were diagnosed as a case of idiopathic thrombocytopenic purpura after excluding other causesof thrombocytopenia. In all cases steroids were stopped either due to non responsiveness or severe side effects.Splenectomy was done in all 17 patients included in the study, after immunization and maintaining the plateletcount with in near normal range by platelet transfusion. Post operative platelet count was monitored andimprovement in clinical parameters was recorded. Results: All 17 patients showed improvement in plateletcount and clinical symptom. Mortality remained zero despite of inclusion of high risk diabetics andhypertensives. Conclusion: when steroids become ineffective, splenectomy becomes the definitive therapeutictool to control the effects of low platelet count.
Multiple Thromboses in a Patient with Systemic Lupus Erythematosus after Splenectomy
Deng-Ho Yang
Case Reports in Immunology , 2012, DOI: 10.1155/2012/813629
Abstract: Antiphospholipid syndrome is a disorder presenting with arterial or venous thrombus and a history of fetal loss. Early diagnosis and adequate treatment is important to prevent multiple organ failures. Here, we described a woman with a two-year history of systemic lupus erythematosus with severe nephrotic syndrome, manifested multiple thrombi over the portal vein and the inferior vena cava, combined with acute renal infarction. The patient underwent splenectomy 10 months ago. Initially, she received anticoagulant treatment and low-dose glucocorticoid, but multiple organ failure progressed. After emergency plasma exchange followed by glucocorticoid pulse therapy, the patient recovered.
Anaesthetic management of a patient with Eisenmenger syndrome and β-thalassemia major for splenectomy  [cached]
Gupta Nishkarsh,Kaur Sarbjot,Goila Ajay,Pawar Mridula
Indian Journal of Anaesthesia , 2011,
Abstract: We describe for the first time, the perioperative care of a patient with a rare combination of Eisenmenger syndrome with β-thalassemia major presenting for splenectomy. Patients with Eisenmenger syndrome have polycythemia because of chronic hypoxia but our patient was anaemic and had thrombocytopenia because of thalassemia major. The management of such a case can be challenging for any anaesthesiologist because of severe V/Q mismatch (high shunt fraction and restrictive lung disease because of hypersplenism), decreased oxygen carrying capacity (anaemia) and increased risk of haemorrhage (thrombocytopenia), along with the potential increase in intracardiac shunt during anaesthesia.
Multiple Thromboses in a Patient with Systemic Lupus Erythematosus after Splenectomy  [PDF]
Deng-Ho Yang
Case Reports in Immunology , 2012, DOI: 10.1155/2012/813629
Abstract: Antiphospholipid syndrome is a disorder presenting with arterial or venous thrombus and a history of fetal loss. Early diagnosis and adequate treatment is important to prevent multiple organ failures. Here, we described a woman with a two-year history of systemic lupus erythematosus with severe nephrotic syndrome, manifested multiple thrombi over the portal vein and the inferior vena cava, combined with acute renal infarction. The patient underwent splenectomy 10 months ago. Initially, she received anticoagulant treatment and low-dose glucocorticoid, but multiple organ failure progressed. After emergency plasma exchange followed by glucocorticoid pulse therapy, the patient recovered. 1. Introduction Systemic lupus erythematosus (SLE) is an autoimmune disease with multiple organ involvement and is a common cause of secondary antiphospholipid syndrome (APS). APS is defined by arterial or venous thrombus, recurrent fetal loss, and thrombocytopenia with positive antibodies including lupus anticoagulant (LA), anticardiolipin antibodies (aCL), and antibodies to β2-glycoprotein-I (anti-β2GPI) [1, 2]. Thrombus-induced various organ infarctions such as deep vein thrombosis, stroke, pulmonary embolism, bowel, or heart ischemia, which are common in SLE patients with secondary APS. Here, we report a patient with SLE and secondary APS with coexisting renal infarction and a large thrombus over the portal vein and the inferior cava. 2. Case Report In January 2006, a 33-year-old woman was diagnosed with SLE, based on malar rash, positive ANA (1?:?640, mixed pattern), high titer of anti-dsDNA (140?IU/mL, normal <10), and autoimmune hemolytic anemia. Since then, she received immunosuppressive medications including prednisolone, azathiopurine, and hydroxychloroquine. In January 2007, splenectomy was performed on account of refractory hemolytic anemia and thrombocytopenia. In June 2007, severe nephritic syndrome with urine daily protein loss (DPL) 8?g developed. She received renal biopsy, and the biopsy revealed membranous glomerulonephritis. Monthly pulses of cyclophosphamide combined with pulse corticosteroids therapy was initiated thereafter; however, the response was poor. Persistent proteinuria (urine DPL: 5 to 10?g) was still found. In November 2007, she presented with intermittent abdominal pain in the emergency room. Physical examination revealed decreased bowel sound, positive shifting dullness, rebounding tenderness in the right lower quadrant, left costovertebral-angle tenderness, and peripheral bilateral leg edema. Laboratory data revealed the following
Total Splenectomy due to an Unexpected “Complication” after Successful Extended Laparoscopic Partial Decapsulation of a Giant Epidermoid Splenic Cyst: A Case Report
Michail Pitiakoudis,Petros Zezos,Anastasia Oikonomou,Prodromos Laftsidis,Georgios Kouklakis,Constantinos Simopoulos
Case Reports in Medicine , 2011, DOI: 10.1155/2011/318208
Abstract: Splenic cysts are rare entities and are classified as true cysts or pseudocysts based on the presence of an epithelial lining. Congenital nonparasitic true cysts can be epidermoid, dermoid, or endodermoid, present at a young age, and are commonly located in the upper pole of the spleen. Surgical treatment is recommended for symptomatic, large (more than 5 cm), or complicated cysts. Depending on cyst number, location, relation to hilus, and the major splenic vessels, the surgical options include aspiration, marsupialization, cystectomy, partial cystectomy (decapsulation), and partial or complete splenectomy. Laparoscopic techniques have now become the standard approach for many conditions, including the splenic cysts, with emphasis on the spleen-preserving minimally invasive operations. We present the successful extended partial laparoscopic decapsulation of a giant epidermoid splenic cyst in a young female patient that, although asymptomatic, was unfortunately followed by complete splenectomy five days later due to a misinterpreted abdominal CT suggesting splenic postoperative ischemia.
Delayed Presentation of Intussusception with Perforation after Splenectomy in Patient with Blunt Abdominal Trauma  [PDF]
Ibrahim Afifi,Hassan Al-Thani,Sajid Attique,Sherwan Khoschnau,Ayman El-Menyar,Rifat Latifi
Case Reports in Surgery , 2013, DOI: 10.1155/2013/510701
Abstract: Adult intussusception (AI) following blunt abdominal trauma (BAT) is a rare surgical condition. We present a case of delayed diagnosis of ileocecal junction intussusception with a perforation of small bowel in a 34-year-old male with a history of fall from height. Initial exploratory laparotomy revealed shattered spleen requiring splenectomy. Initial abdominal computerized tomography scanning (CT) scan showed dilated small bowel with no organic obstruction. Patient started to improve with partial distention and was shifted to rehabilitation unit. On the next day, he experienced severe abdominal distention and vomiting. Abdominal CT showed characteristic intussusception at the distal ileum. Secondary exploratory laparotomy revealed severe adhesions of stomach and small bowel to the anterior abdominal wall with dilated small bowel loops and intussusception near the ileocecal junction with perforation of small bowel. The affected area was resected and side-to-side stapled anastomosis was performed. Though small bowel intussusception is a rare event, BAT patients with delayed symptoms of bowel obstruction should be carefully evaluated for missed intussusception. 1. Introduction Intussusception is the telescoping of one segment of the gastrointestinal tract into an adjacent one and usually occurs in children [1]. John Hunter was the first to describe the clinical and pathological characteristics of intussusceptions. Sir Fredrick Treves proposed the first management plan for intussusception which is being practiced to date [2]. Unlike children in whom most cases are idiopathic, the majority (80%) of adult intussusception (AI) cases have an underlying cause which could be due to development of tumors, fibrosis after surgery, and Meckel’s diverticula. Cases following blunt abdominal trauma are rare [3]. AI is relatively uncommon with different clinical presentation, diagnosis, and management compared to childhood intussusception [4]. AI is often diagnosed late during emergency laparotomy and the delayed diagnosis may be attributed to nonspecific presentation such as chronic colicky pain and intermittent partial intestinal obstruction associated with nausea and vomiting [5]. AI mainly needs surgical treatment which includes bowel resection with prior reduction of intussusception [4]. The increased utility of computerized tomography scanning (CT) helps in early evaluation of patients with abdominal pain and confirms the diagnosis for the possible AI without subsequent delay [1]. Definitive diagnosis of intussusception is possible due to its marked diagnostic
Splendid and perverse equivalences  [PDF]
Léo Dreyfus-Schmidt
Mathematics , 2014,
Abstract: Inspired by the works of Rickard on splendid equivalences and of Chuang and Rouquier on perverse equivalences, we are here interested in the combination of both, a splendid perverse equivalence. This is naturally the right framework to understand the relations between global and local perverse equivalences between blocks of finite groups, as a splendid equivalence induces local derived equivalences via the Brauer functor. We prove that under certain conditions, we have an equivalence between a perverse equivalence between the homotopy category of p-permutation modules and local derived perverse equivalences, in the case of abelian defect group.
Single Stage Aortic Valve Replacement and Splenectomy in a Patient with Severe Aortic Stenosis
Rezayat Parvizi,Rasoul Ibrahim Abdulrahman,Rezvaneh Salehi,Ghader Shah Mohamadi
Journal of Tehran University Heart Center , 2010,
Abstract: Splenomegaly-induced thrombocytopenia is fully described in hematological and surgical literature, but its association with severe aortic stenosis is rare. We present a case of severe aortic valve stenosis with severe splenomegaly-induced thrombocytopenia in which aortic valve replacement was done with a number 23 homograft and splenectomy was performed after the end of cardiopulmonary bypass. Platelet count turned to normal value post-operatively, and the patient spent an ordinary convalescence period and was discharged from the hospital without any complications.
LARGE SPLENIC CYSTS AT THE UPPER POLE OF THE SPLEEN – LAPAROSCOPIC MANAGEMENT  [PDF]
V. ?urlin,E. Georgescu,S. Ramboiu,Cristiana Dumitrescu
Jurnalul de Chirurgie , 2011,
Abstract: Splenic cysts represent a rather rare pathology. The traditional management consisted in splenectomy and it is performed more and more frequently by laparoscopy. However, with the recognition of the important immunological function of the spleen, new techniques to preserve splenic function as fenestration, cystectomy or partial splenectomy may be considered. The authors present the cases of 2 women of 17 and 23 years old in whom dynamic enhanced intravenous contrast computed tomography revealed 2 cystic lesions located in the upper pole of the spleen, measuring 7 and 10 cm in diameter with thin walls and homogenous low-density fluid content. Serology for hydatic cyst was negative. The patients were approached by laparoscopy in a right lateral decubitus position. In the first case, only a small area from the upper part of the cyst was visible, outside the spleen parenchyma, needle aspiration removing clear, yellowish fluid. A partial cystectomy was possible after posterior and superior mobilization of spleen attachments, removing almost two-thirds of the cystic wall with spleen parenchyma around it, to avoid recurrence. In the second case, the cyst was not visible, being completely surrounded by parenchyma. Splenectomy was decided and performed. Both cases evolved uneventfully. Histopathology report indicated epithelial cysts in both cases. The conservative laparoscopic management of large splenic cysts is more difficult when located in the upper pole and almost entirely surrounded by parenchyma. Splenectomy is safer for the patient if the true nature of the cyst could not be established before or during the intervention.
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