Delayed Splenic Rupture Following Occult Injury: Differentiation from Splenic Abscess: A Case Report

隱藏性傷害後延遲性脾臟破裂與脾臟膿瘍區別：病例報告

侯民波(Min-Po Ho) ； 蔡光超(Kuang-Chau Tsai) ； 林恆甫(Heng-Fu Lin) ； 陳國鋅(Kuo-Hsin Chen) ； 蔡建誠(Chien-Cheu Tsai)

《中華民國急救加護醫學會雜誌》 16卷4期 (2005/12) Pp. 159-164

https://doi.org/10.30018/JECCM.200512.0004

摘要

脾臟膿瘍是罕見且對生命具有威脅性的疾病。因為不特定的臨床表現，至今此疾病仍是有挑戰性的診斷。一旦破裂到腹腔內是最嚴重併發症且死亡率極高。我們遇有一位四十五歲男性病患腰部受傷後表現延遲性脾臟破裂併脾臟膿瘍導致腹腔內積血。腹部超音波表現多發性脾臟膿瘍破裂併腹腔內及脾臟周圍有液體。做腹部電腦斷層掃瞄進一步確認結果。腹部穿刺放液時發現沒有凝固的血液，故考慮腹腔內積血。病患有接受緊急輸液，輸血，脾臟切除術及注射廣泛的抗生素。術後療程順利，七天後平安出院。

關鍵字

脾臟膿瘍 ； 脾臟血腫 ； 延遲脾臟破裂 ； 腹腔內積血

並列摘要

Splenic abscess is a rare and potentially life-threatening disease. Because of the nonspecific clinical picture, it still remains a diagnostic challenge. Rupture into the peritoneal cavity is the most severe complication because it is associated with a high mortality rate. We report a case of delayed splenic rupture complicated by splenic abscess following a flank injury leading to hemoperitoneum in a 45-year-old man. Abdominal sonography showed multiple splenic abscesses with intraperitoneal and perisplenic fluid accumulation. This diagnosis was confirmed by computed tomographic scan of the abdomen. Abdominal paracentesis yielded uncoagulated blood and hemoperitoneum was suspected. He was urgently treated with fluid resuscitation, blood transfusions, broad-spectrum antibiotics and emergency splenectomy. His postoperative course was uneventful and he was discharged in good condition after 7 days.

並列關鍵字

splenic abscess ； splenic hematoma ； delayed splenic rupture ； hemoperitoneum