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Splenic hematoma may present as large bowel obstruction: A case report

INTRODUCTION: Large bowel obstruction (LBO) warrants prompt evaluation and management. Although causes of LBO are most commonly intrinsic to the colon (e.g. malignancy, diverticular stricture, intussusception or volvulus), rare extrinsic etiologies exist. An extremely rare extrinsic etiology of LBO...

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Autores principales: Kolwitz, Christine, Esposito, Christopher, Gauvin, Caitlin, Gaduputi, Vinaya, Chiong, Brian, Sunkara, Tagore, Baltazar, Gerard A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312797/
https://www.ncbi.nlm.nih.gov/pubmed/30599304
http://dx.doi.org/10.1016/j.ijscr.2018.11.012
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author Kolwitz, Christine
Esposito, Christopher
Gauvin, Caitlin
Gaduputi, Vinaya
Chiong, Brian
Sunkara, Tagore
Baltazar, Gerard A.
author_facet Kolwitz, Christine
Esposito, Christopher
Gauvin, Caitlin
Gaduputi, Vinaya
Chiong, Brian
Sunkara, Tagore
Baltazar, Gerard A.
author_sort Kolwitz, Christine
collection PubMed
description INTRODUCTION: Large bowel obstruction (LBO) warrants prompt evaluation and management. Although causes of LBO are most commonly intrinsic to the colon (e.g. malignancy, diverticular stricture, intussusception or volvulus), rare extrinsic etiologies exist. An extremely rare extrinsic etiology of LBO described only once, is compressive splenic hematoma. PRESENTATION OF CASE: A 64-year-old female presented to the emergency department complaining of two days of diffuse abdominal pain and distension, watery diarrhea and nausea subsequent to a mechanical fall to her left side. Computed tomography demonstrated a grade 3 splenic hematoma with active extravasation, causing extrinsic compression and obstruction of the colon. Embolization of the splenic artery was performed, and non-operative LBO management resulted in resumption of normal bowel function after six days. DISCUSSION: To our knowledge, the only other case of colonic compression by splenic hematoma (a case report in the radiology literature from 1994) describes a 62-year-old male whose symptoms similarly spontaneously resolved. Increasing frequency of non-operative management of splenic trauma may result in increased frequency of splenic hematoma complications. Physicians and surgeons who treat LBO should be aware of this rare etiology and its potential for non-operative management. CONCLUSION: Our case demonstrates the importance of considering splenic hematoma as an etiology of LBO, particularly in the setting of trauma and that management of this entity can be successfully non-operatively.
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spelling pubmed-63127972019-01-07 Splenic hematoma may present as large bowel obstruction: A case report Kolwitz, Christine Esposito, Christopher Gauvin, Caitlin Gaduputi, Vinaya Chiong, Brian Sunkara, Tagore Baltazar, Gerard A. Int J Surg Case Rep Article INTRODUCTION: Large bowel obstruction (LBO) warrants prompt evaluation and management. Although causes of LBO are most commonly intrinsic to the colon (e.g. malignancy, diverticular stricture, intussusception or volvulus), rare extrinsic etiologies exist. An extremely rare extrinsic etiology of LBO described only once, is compressive splenic hematoma. PRESENTATION OF CASE: A 64-year-old female presented to the emergency department complaining of two days of diffuse abdominal pain and distension, watery diarrhea and nausea subsequent to a mechanical fall to her left side. Computed tomography demonstrated a grade 3 splenic hematoma with active extravasation, causing extrinsic compression and obstruction of the colon. Embolization of the splenic artery was performed, and non-operative LBO management resulted in resumption of normal bowel function after six days. DISCUSSION: To our knowledge, the only other case of colonic compression by splenic hematoma (a case report in the radiology literature from 1994) describes a 62-year-old male whose symptoms similarly spontaneously resolved. Increasing frequency of non-operative management of splenic trauma may result in increased frequency of splenic hematoma complications. Physicians and surgeons who treat LBO should be aware of this rare etiology and its potential for non-operative management. CONCLUSION: Our case demonstrates the importance of considering splenic hematoma as an etiology of LBO, particularly in the setting of trauma and that management of this entity can be successfully non-operatively. Elsevier 2018-11-22 /pmc/articles/PMC6312797/ /pubmed/30599304 http://dx.doi.org/10.1016/j.ijscr.2018.11.012 Text en © 2018 The Author(s) http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kolwitz, Christine
Esposito, Christopher
Gauvin, Caitlin
Gaduputi, Vinaya
Chiong, Brian
Sunkara, Tagore
Baltazar, Gerard A.
Splenic hematoma may present as large bowel obstruction: A case report
title Splenic hematoma may present as large bowel obstruction: A case report
title_full Splenic hematoma may present as large bowel obstruction: A case report
title_fullStr Splenic hematoma may present as large bowel obstruction: A case report
title_full_unstemmed Splenic hematoma may present as large bowel obstruction: A case report
title_short Splenic hematoma may present as large bowel obstruction: A case report
title_sort splenic hematoma may present as large bowel obstruction: a case report
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6312797/
https://www.ncbi.nlm.nih.gov/pubmed/30599304
http://dx.doi.org/10.1016/j.ijscr.2018.11.012
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