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“游走脾伴急性扭转”:成人脾切除术的罕见适应证,术后并发肠系膜静脉血栓形成和肠坏死。

'Wandering spleen with acute torsion' : a rare indication for splenectomy in an adult, complicated by postoperative splanchnic venous thrombosis and intestinal gangrene.

机构信息

General Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

General and Upper Gastrointestinal Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India

出版信息

BMJ Case Rep. 2021 Feb 4;14(2):e238647. doi: 10.1136/bcr-2020-238647.

Abstract

Wandering spleen (WS) is a hypermobile spleen that, due to the laxity of its ligaments, is prone to torsion. We report a case of a 45-year-old multiparous woman who presented with acute abdominal pain and a tender palpable mass. A contrast-enhanced computed tomography scan of the abdomen showed a WS with torsion. She underwent an emergency splenectomy and was discharged after an uneventful recovery. She was readmitted with splanchnic venous thrombosis and was managed with therapeutic low-molecular-weight heparin (LMWH) and discharged. Twenty days later, she presented with new-onset abdominal pain. She had not complied with LMWH as advised. The thrombosis had progressed, leading to small bowel gangrene, requiring resection and a stoma. Due to frequent metabolic disturbances, an early reversal of stoma was performed. She was lost to follow-up thereafter. This case highlights a rare indication for emergency splenectomy and one of its major postoperative complications.

摘要

游走脾(WS)是一种活动度较大的脾脏,由于其韧带松弛,容易发生扭转。我们报告了一例 45 岁多产妇,表现为急性腹痛和可触及的压痛肿块。腹部增强 CT 扫描显示 WS 伴扭转。她接受了紧急脾切除术,术后恢复顺利出院。她因脾静脉血栓形成再次入院,接受了低分子肝素(LMWH)治疗并出院。20 天后,她出现新的腹痛。她没有按照建议使用 LMWH。血栓进展导致小肠坏死,需要切除和造口。由于经常发生代谢紊乱,早期进行了造口逆转。此后她失去了随访。本例提示了急诊脾切除术的罕见适应证及其主要术后并发症之一。

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Acute abdomen due to an infarction of wandering spleen: case report.游走脾梗死致急腹症:病例报告
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Torsion of wandering spleen involving the pancreatic tail.游走脾扭转累及胰尾。
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Splanchnic Vein Thrombosis: Current Perspectives.内脏静脉血栓形成:当前观点
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Wandering spleen torsion-use of contrast-enhanced ultrasound.游走脾扭转——超声造影的应用
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Torsion of Wandering Spleen with Infarction.游走脾扭转伴梗死
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