López de Guimaraes Douglas, Menacho López Julio, Villanueva Palacios Jovita, Mosquera Vásquez Vitaliano
Jefe del Departamento de Emergencia del Hospital VIctor RAmos Guardia de Huaraz, Universidad Nacional de Ancash, Perú.
Rev Gastroenterol Peru. 2009 Apr-Jun;29(2):179-84.
We report three cases of splenic infarction in healthy men for the first time that amounted to high altitudes, observed in the hospital "Victor Ramos Guardia" Huaraz (3100 m). Case 1 (1995) of 55 years, born in Cuba, from Lima, caucasian suddenly presented acute abdominal pain in epigastrium, distension, nausea and vomiting, was laparotomized for acute abdomen and surgical pathology revealed thrombosis with splenic infarction splenic artery and vein. During follow-up in Lima, hemoglobin electrophoresis showed that it was heterozygous carrier of the sickle trait (Hb A: 57% Hb S: 38.5%). Case 2 (1998) of 23 years, born in Cuba, from Lima, Black said acute abdominal pain in left hypochondrium, shortness of breath and chest pain, clinical examination and radiography of the abdomen showed the spleen volume increased. Case 3 (2006) of 17 years, natural and from Lima, mestizo, who came on tour promotion, acute abdominal pain referred onset in the epigastrium and left hypochondrium, headache, increase heat, nausea and vomiting, pharyngitis was found acute and painful, and spleen increased in size by clinical and x-ray of abdomen simple stand. None had no history of hemoglobinopathy and anemia. In general, medical management was supportive and cases 2 and 3 are recommended hemoglobin electrophoresis. We conclude that we must think of splenic infarction associated with height in any healthy person who is first at high altitude (> 3000m) and having a sudden acute abdominal pain in epigastrium and / or left hypochondrium, pain and palpable spleen and radiological study compatible with image. In this case is indicated by hemoglobin electrophoresis to determine whether there is an individual heterozygous carrier of the sickle trait.
splenic infarction, high altitude, sickle trait, Huaraz.
我们首次报告了3例在海拔较高地区出现脾梗死的健康男性病例,这些病例是在瓦拉斯的“维克托·拉莫斯·瓜迪亚”医院(海拔3100米)观察到的。病例1(1995年),55岁,出生于古巴,来自利马,白种人,突然出现上腹部急性腹痛、腹胀、恶心和呕吐,因急腹症接受剖腹手术,手术病理显示脾动脉和静脉血栓形成伴脾梗死。在利马随访期间,血红蛋白电泳显示其为镰状细胞性状杂合子携带者(Hb A:57%,Hb S:38.5%)。病例2(1998年),23岁,出生于古巴,来自利马,黑人,诉说左季肋部急性腹痛、呼吸急促和胸痛,临床检查及腹部X线检查显示脾脏体积增大。病例3(2006年),17岁,利马本地人,混血儿,因巡回促销前来,上腹部和左季肋部突发急性腹痛,伴有头痛、发热、恶心和呕吐,发现急性疼痛性咽炎,经临床检查和腹部简易站立位X线检查发现脾脏增大。三人都无血红蛋白病和贫血病史。一般来说,医疗处理为支持性治疗,建议对病例2和病例3进行血红蛋白电泳检查。我们得出结论,对于任何首次处于高海拔(>3000米)且突然出现上腹部和/或左季肋部急性腹痛、疼痛且可触及脾脏以及影像学检查结果与之相符的健康人,必须考虑与高海拔相关的脾梗死。在这种情况下,通过血红蛋白电泳检查来确定个体是否为镰状细胞性状杂合子携带者。
脾梗死;高海拔;镰状细胞性状;瓦拉斯