腹腔镜气腹术后急性脾破裂：一例报告
Acute splenic rupture following laparoscopic pneumoperitoneum: A case report.
作者信息
Delafontaine Jean-Luc, Moreci Rebecca, Samra Navdeep S
机构信息
Department of Surgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA.
Louisiana State University School of Medicine, Shreveport, LA, USA.
出版信息
Trauma Case Rep. 2019 Jul 9;22:100211. doi: 10.1016/j.tcr.2019.100211. eCollection 2019 Aug.
INTRODUCTION
Splenic rupture after laparoscopic surgery is a very rare complication. In this study, we report a case of a splenic laceration that occurred during a laparoscopic gastrostomy tube placement. The theorized mechanism in this case was acute disruption of a peri-splenic hematoma.
CASE REPORT
A 64-year-old African-American male presented after a motor vehicle accident with multiple injuries and was admitted to a surgical intensive care unit, where he declined from ICU days 6 through 11. The patient underwent tracheostomy and laparoscopic gastrostomy tube placement given his significant neurologic deficits. Intraoperatively, the patient developed hypotension, leading to the discovery of hemoperitoneum and necessitating an emergent open splenectomy.
CONCLUSION
Splenic rupture following laparoscopic procedures is a very rare phenomenon. In this case, we believe the splenic rupture was secondary to an acute disruption of a previously hemostatic splenic hematoma involving the abdominal wall during creation of capnoperitoneum.
引言
腹腔镜手术后脾破裂是一种非常罕见的并发症。在本研究中，我们报告了一例在腹腔镜胃造口管置入过程中发生脾裂伤的病例。该病例的理论机制是脾周血肿的急性破裂。
病例报告
一名64岁的非裔美国男性在机动车事故后出现多处损伤，被收入外科重症监护病房，在重症监护病房的第6天至第11天病情恶化。鉴于患者存在严重的神经功能缺损，接受了气管切开术和腹腔镜胃造口管置入术。术中，患者出现低血压，导致发现腹腔积血，遂行急诊开放性脾切除术。
结论
腹腔镜手术后脾破裂是一种非常罕见的现象。在本病例中，我们认为脾破裂继发于在建立气腹过程中涉及腹壁的先前已止血的脾血肿的急性破裂。
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