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一例伪装成心肌缺血的创伤性脾破裂罕见病例:病例报告

An unusual case of a traumatic splenic rupture masquerading as myocardial ischemia: a case report.

作者信息

Munasinghe B M, Fernando U P M, Kumar Thileep, Huruggamuwa Chamika, Kuruppu K A R L, Hewawasam G G C

机构信息

Department of Anaesthesiology and Intensive care, District General Hospital, Mannar, Sri Lanka.

Department of Anaesthetics, Queen Elizabeth the Queen Mother Hospital, Margate, UK.

出版信息

Int J Emerg Med. 2022 Nov 17;15(1):63. doi: 10.1186/s12245-022-00469-7.

Abstract

BACKGROUND

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.

CASE PRESENTATION

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.

CONCLUSION

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).

摘要

背景

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。

病例报告

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。

结论

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d91d/9670567/578747d97956/12245_2022_469_Fig1_HTML.jpg

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