• Journal of Trauma and Injury
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• v.26 no.1
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• pp.34-37
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• 2013

Although a majority of patients with splenic rupture present acutely, up to 15% present with a delayed rupture days to weeks following a substantial abdominal injury. The mortality for patients presenting with acute splenic rupture is approximately 1% whereas that associated with delayed rupture approaches 15%. Although many cases of delayed splenic rupture have been reported, the majority of those reports present delayed splenic rupture associated with an underlying systemic disorder such as liver or kidney disease, or another hematologic disorder. We found a delayed splenic rupture case that documented the normal spleens of young healthy soldiers after trivial abdominal trauma, and we have had successful treatment experience with delayed rupture of a normal spleen after trivial trauma. Therefore, we want to review the literature and discuss the phenomenon of delayed rupture of the spleen following trivial trauma.

• Journal of Trauma and Injury
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• v.24 no.1
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• pp.52-55
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• 2011

The spleen is the most frequently injured organ following blunt abdominal trauma. However, delayed splenic rupture is rare. As the technical improvement of computed tomography has proceeded, the diagnosis of splenic injury has become easier than before. However, the diagnosis of delayed splenic rupture could be challenging if the trauma is minor and remote. We present a case of delayed splenic rupture in a patient with underlying liver cirrhosis. A 42-year-old male visited our emergency department with pain in the lower left chest following minor blunt trauma. Initial physical exam and abdominal sonography revealed only liver cirrhosis without traumatic injury. On the sixth day after trauma, he complained of abdominal pain and diarrhea after eating snacks. The patient was misdiagnosed as having acute gastroenteritis until he presented with symptoms of shock. Abdominal sonography and computed tomography revealed the splenic rupture. The patient underwent a splenectomy and then underwent a second operation due to postoperative bleeding 20 hours after the first operation. The patient was discharged uneventfully 30 days after trauma. In the present case, the thrombocytopenia and splenomegaly due to liver cirrhosis are suspected of being risk factors for the development of delayed splenic rupture. The physician should keep in mind the possibility of delayed splenic rupture following blunt abdominal or chest trauma.

• Journal of Trauma and Injury
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• v.27 no.4
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• pp.208-210
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• 2014

Rupture of the spleen is relatively common, both immediately and in a delayed fashion following significant blunt abdominal trauma. However, atraumatic splenic rupture rarely occurs. Multiple underlying pathologies have been associated with splenic rupture without trauma, including hematological, neoplastic, inflammatory and infectious conditions. In our case, a 21-year-old male without prior medical history visited the hospital with left upper quadrant abdominal pain that had started one day earlier. He had no history of trauma. An abdominal computed tomography (CT) scan found a collection of perisplenic fluid, accompanying a splenic rupture. Due to the patient's stable vital signs and lack of clinical progression of hemorrhage, he underwent conservative treatment. The patient was discharged at day 14 without complication. Rupture of a normal spleen without a history of trauma is not often reported, and it has long been a subject of debate. Ruptures of normal spleen almost always follow some kind of trauma, such as a car accidents or a fall from significant heights. Here, we report a case of spontaneous rupture of a normal spleen in the absence of other medical pathologies or triggering factors.

• Journal of Veterinary Clinics
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• v.37 no.6
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• pp.355-359
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• 2020

Contrast-enhanced ultrasonography (CEUS) has been applied to evaluate parenchymal organs in human and veterinary medicine. However, to our knowledge, there is no report on the identification of active bleeding and the bleeding site in veterinary clinical patients. Herein, we describe the use of CEUS in two cases of abdominal bleeding caused by ruptured lesions with malignant abdominal tumors. One dog had a splenic hemangiosarcoma, which had metastasized to the liver; the other dog had hepatic cell carcinomas in the left hepatic lobe, which were lobectomized, and another nodule was identified in the right hepatic lobe. Immediately after the rupture of these oncogenic lesions was suspected, CEUS was performed to identify the bleeding sites. The active bleeding sites were confirmed by hyperechoic pooling signs in the arterial phase, and extravasation could be observed within the defects showing hypoechoic perfusions in the delayed phase of the CEUS. Microbubbles were also observed in the ascites; thus, CEUS could detect the presence of hemorrhage and accurately identify the bleeding site. Collectively, the study findings suggest the usefulness of CEUS in emergent situations as it enables rapid and noninvasive evaluation of bleeding points in case of active bleeding in dogs.

• Journal of Chest Surgery
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• v.37 no.2
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• pp.146-153
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• 2004

As the experience of coronary artery bypass grafting (CABG) has been accumulated, the number of reoperation after CABG is increasing. We analyzed our clinical experience of redo-CABG. Material and Method: Fourteen patients who underwent redo-CABG between Jan. 1994 and Dec. 2002 were included in this study. The mean period from the first operation to reoperation was 66$\pm$56 (3∼157) months, and the average ages were 62.8$\pm$8.7 (51∼78) years. The survivors were followed up 39$\pm$29 (4∼101) months postoperatively. Indications of reoperation were stenosis or occlusion of previous grafts in 11 patients, progression of native coronary artery disease in one patient, and both etiologies in two patients. Result: There were two in-hospital mortalities (14.3%) resulting from low cardiac output syndrome, Postoperative morbidities were perioperative myocardiac infarction in 2 patients (14.3%), mediastinitis in one patient (7.2%), duodenal perforation in one patient, ischemic necrosis of the lower extremity in one patient, gastric perforation after mesenteric infarct in one patient, delayed brain infarct in one patient, and intraoperative splenic rupture in one patient. There was one late mortality at six months postoperatively during the follow up. There was no angina recurrence during the follow up. Conclusion: Although redo CABG demonstrated relatively high operative mortalities and morbidities, postoperative status and clinical outcome of the survivors were favorable.