Turner Benedict R H, Barnacle James, Sheth Hemant
Department of Surgery and Cancer, Imperial College London, London, UK.
Infectious Diseases, London Northwest NHS Healthcare Trust, London, UK.
J Surg Case Rep. 2021 Nov 29;2021(11):rjab525. doi: 10.1093/jscr/rjab525. eCollection 2021 Nov.
Instances of foreign bodies impacted in solid organs are rare, and rarer still are reports of objects in the spleen. A 42-year-old presented septic with abdominal pain, high inflammatory markers and haemodynamic instability. She was found to have a splenic haematoma and a 4-cm hyperdense foreign body within the spleen. Ultrasound-guided drainage of the haematoma isolated and conservative management with intravenous antibiotics avoided the need for emergency splenectomy. The bacterium isolated was the same cultured 9 months previously from the patient's empyema fluid. The origin of the foreign body was not identified, though is made of metal and pre-dates any hospital admissions. The case raised the question of how an object might penetrate the spleen without knowledge of the patient and highlighted the risks of foreign body-associated sepsis, the risks and benefits of emergency splenectomy and management of complex cases with paucity of evidence.
异物嵌顿于实质性器官的情况罕见，而关于脾脏内有异物的报道更是稀少。一名42岁女性因腹痛、炎症指标升高和血流动力学不稳定而出现感染症状。检查发现她有脾血肿，脾脏内有一个4厘米的高密度异物。在超声引导下对血肿进行引流并隔离，同时采用静脉注射抗生素进行保守治疗，避免了急诊脾切除术。分离出的细菌与9个月前从该患者脓胸液中培养出的细菌相同。虽然异物由金属制成且早于任何住院记录，但异物的来源尚未确定。该病例引发了一个问题，即异物如何在患者不知情的情况下穿透脾脏，突出了异物相关败血症的风险、急诊脾切除术的风险和益处以及证据不足的复杂病例的管理问题。
