Kaufman Nicholas, Ferraro David
Department of Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas, USA.
Department of Pulmonary & Critical Care, Brooke Army Medical Center, Fort Sam Houston, Texas, USA.
BMJ Case Rep. 2017 Aug 7;2017:bcr-2017-221288. doi: 10.1136/bcr-2017-221288.
Atraumatic rupture of the normal spleen is a rare entity. Often, a triggering factor or minor physical event can be ascribed as the aetiology for rupture, including coughing, vomiting or minor medical procedures not involving the spleen. A 65-year-old man who was hospitalised for eosinophilic pneumonia developed haemodynamically unstable atrial flutter that necessitated urgent synchronised direct current cardioversion (DCCV). Two hours after successful cardioversion, he developed signs of an acute abdomen with free intraperitoneal fluid identified on bedside ultrasonography. Exploratory laparotomy revealed gross haemoperitoneum and splenic rupture requiring splenectomy. With exception of capsular defects and haemorrhage suggestive of organ rupture, the gross and histological examination of the spleen was otherwise unremarkable. The patient denied recent trauma. The cause of his spleen rupture was attributed to cardioversion and subsequent abdominal muscle contraction. This represents the first known case of splenic rupture associated with DCCV.
正常脾脏的非创伤性破裂是一种罕见的情况。通常，可将触发因素或轻微身体事件归因于破裂的病因，包括咳嗽、呕吐或不涉及脾脏的小型医疗程序。一名因嗜酸性粒细胞性肺炎住院的65岁男性发生了血流动力学不稳定的心房扑动，需要紧急同步直流电复律（DCCV）。成功复律两小时后，他出现了急腹症的体征，床边超声检查发现腹腔内有游离液体。剖腹探查显示腹腔内大量积血和脾破裂，需要进行脾切除术。除了提示器官破裂的包膜缺损和出血外，脾脏的大体和组织学检查未见异常。患者否认近期有外伤史。他脾破裂的原因归因于复律及随后的腹部肌肉收缩。这是已知的首例与DCCV相关的脾破裂病例。
