Munasinghe B M, Fernando U P M, Kumar Thileep, Huruggamuwa Chamika, Kuruppu K A R L, Hewawasam G G C
Department of Anaesthesiology and Intensive care, District General Hospital, Mannar, Sri Lanka.
Department of Anaesthetics, Queen Elizabeth the Queen Mother Hospital, Margate, UK.
Int J Emerg Med. 2022 Nov 17;15(1):63. doi: 10.1186/s12245-022-00469-7.
The spleen is one of the most frequently injured abdominal organs during trauma, which can result in intraperitoneal bleeding of life-threatening magnitude. Although splenic injury secondary to trivial trauma comprises a minor fraction of abdominal injuries, undiagnosed or delayed diagnosis may result in a complicated clinical course.
One such event is presented here, wherein a late diagnosis of an advanced grade splenic injury following a trivial trauma initially presented in disguise as acute myocardial ischaemia in a previously healthy South Asian woman in her late 30s. Emergency laparotomy and splenectomy were performed with simultaneous massive transfusion for a 3.5-L blood loss. She subsequently had an uncomplicated clinical course with regular surgical follow-up.
Splenic injuries might present with ambiguous symptoms such as atypical chest pain and shoulder pain, necessitating attending clinicians to have a high degree of suspicion, especially in busy units such as the emergency department (ED).
脾脏是创伤期间腹部最常受伤的器官之一，可导致危及生命的腹腔内出血。尽管轻微创伤继发的脾损伤在腹部损伤中占比很小，但未诊断或延迟诊断可能导致复杂的临床病程。
本文介绍了这样一个病例，一名30多岁的健康南亚女性，轻微创伤后晚期诊断为高级别脾损伤，最初表现为急性心肌缺血。紧急剖腹探查并行脾切除术，同时因失血3.5升进行大量输血。随后她的临床病程顺利，接受了定期的外科随访。
脾损伤可能表现为不明确的症状，如非典型胸痛和肩痛，这就要求临床医生高度怀疑，尤其是在急诊科等繁忙科室。
