Spontaneous non-traumatic massive intraabdominal spleen bleeding in young females: Importance of ATLS principles and trauma alarm.

Autor:	Kazaryan AM; Department of Gastrointestinal Surgery, Telemark Hospital, Skien, Norway ; Department of Surgery, Finnmark Hospital, Kirkenes, Norway ; Intervention Center, Oslo University Hospital - Rikshospitalet, Oslo, Norway., Wiborg J; Department of Gastrointestinal Surgery, Telemark Hospital, Skien, Norway ; Department of Gastrointestinal Surgery, Oslo University Hospital - Ullevål, Oslo, Norway., Hauss K; Department of Anesthesiology and Intensive Care, Telemark Hospital, Skien, Norway., Anundsen TK; Department of Gastrointestinal Surgery, Telemark Hospital, Skien, Norway., Flemmen OJ; Department of Gastrointestinal Surgery, Oslo University Hospital - Ullevål, Oslo, Norway., Holm TE; Department of Gastrointestinal Surgery, Telemark Hospital, Skien, Norway., Lauzikas G; Department of Gastrointestinal Surgery, Telemark Hospital, Skien, Norway.
Jazyk:	angličtina
Zdroj:	The American journal of case reports [Am J Case Rep] 2014 May 05; Vol. 15, pp. 189-93. Date of Electronic Publication: 2014 May 05 (Print Publication: 2014).
DOI:	10.12659/AJCR.890730
Abstrakt:	Patient: Female, 28 FINAL DIAGNOSIS: Rupture of the splenic artery aneurysm Symptoms: Hypovolemic shock Medication: - Clinical Procedure: - Specialty: Surgery. Objective: Rare disease. Background: ATLS principles have become a standard of care for trauma patients. However, there is poor documentation in regard to spontaneous non-traumatic life-threatening bleedings. Case Report: Two women, a 21-year-old and a 28-year-old, presented to the admissions department in hemorrhagic shock. The latter woman was in her 26(th) week of pregnancy. The trauma alarm was raised and the patients received prompt, complex diagnostics including ultrasonography verifying massive intraabdominal fluid. Massive infusion therapy was initiated. The first patient was intubated in the emergency room and required cardiopulmonary rescue due to cardiopulmonary arrest. The patients were moved to the surgical theatre for life-saving operations at 30 and 60 minutes, respectively, after arrival in the emergency department. Results: In the first case, we found 4 L of intraabdominal blood and a rupture in the lower pole of the splenic capsule. Splenectomy was performed. The patient developed disseminated intravascular coagulation syndrome and was transferred to a first-level trauma centre for further treatment. She survived with slight sequelae in the form of psychosocial maladjustment, and low-grade spasms and myoclonic twitches due to prolonged brain ischemia. She was steadily improving at 17 months of follow-up. Viral mononucleosis was established as the cause of the spontaneous rupture of the spleen. In the second case, we found 2.5 L of intraabdominal blood and persistent bleeding from an aneurism of the splenic artery. A splenectomy was performed. She was transferred to a first-level trauma centre for further treatment. She lost the fetus and underwent autotransplantation of the right kidney after 3 months, due to the finding of an aneurism of the right renal artery on the abdominal CT. We also found an ectasia in the ascending aorta, which will require follow-up. The patient does not have any other sequelae and has made a complete recovery at 12 months of follow-up. Conclusions: ATLS principles and trauma alarm readiness play a major role in lifesaving surgery in patients with non-traumatic hemorrhagic shock.
Databáze:	MEDLINE
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