Bokman Christine L, Sfeir Maroun, Chahwala Veer, Ginzburg Enrique
DeWitt-Daughtry Family, Department of Surgery, University of Miami Miller School of Medicine and Ryder Trauma Center/Jackson Memorial Hospital, Miami, FL 33136, USA.
Department of Internal Medicine, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, FL 33136, USA.
Case Rep Med. 2014;2014:510259. doi: 10.1155/2014/510259. Epub 2014 Sep 15.
Massive splenic infarction (MSI) is a rare phenomenon that results from compromised blood flow to more than half of the spleen. Causes of MSI include hematological disorders, coagulopathies, infection, and embolization, and, rarely, MSI is spontaneous. The mainstay of treatment is splenectomy. We report the case of a 50-year-old man with a history of renal transplant who presented with diffuse abdominal pain and rapidly developed septic shock. A computed tomographic study (CT scan) of the abdomen demonstrated MSI. The surgical team was consulted for splenectomy but conservative management was maintained and immune function preserved. The patient's clinical condition was resolved over a three-week period. This report demonstrates successful nonoperative management of a spontaneous MSI most likely secondary to hypoperfusion and a hypercoagulable state from both septic shock and renal transplant.
大面积脾梗死（MSI）是一种罕见现象，由超过半数脾脏的血流供应受损所致。MSI的病因包括血液系统疾病、凝血功能障碍、感染和栓塞，极少数情况下为自发性。治疗的主要方法是脾切除术。我们报告一例50岁男性肾移植受者，该患者出现弥漫性腹痛并迅速发展为感染性休克。腹部计算机断层扫描（CT扫描）显示为MSI。手术团队会诊后建议行脾切除术，但维持了保守治疗并保留了免疫功能。患者的临床状况在三周内得到缓解。本报告表明，对于可能继发于感染性休克和肾移植导致的低灌注和高凝状态的自发性MSI，非手术治疗是成功的。
