Abstract
Giriş: Splenik infarkt nadir görülen kritik bir durumdur.
Genellikle hematolojik hastalıklar, vasküler ve tromboembolik
bozukluklardan kaynaklanır.
Olgu Sunumu: Bu makalede 79 yaşında hipertansiyon ve atrial
fibrilasyonu olan bir olgu sunulmuştur. Hasta antiagregan ve
beta bloker tedavi alırken sol üst kadran ağrısı, bulantı, kusma
ve soğuk terleme şikayeti ile acil servise başvurdu. Hastanın
elektrokardiografisinde hızlı ventrikül yanıtlı atrial fibrilasyon
tespit edildi. Batın tomografisi splenik infarkt ile uyumlu bulundu.
Splenik infarkta yönelik yapılan tetkiklerde periferik yayma,
koagülopati testleri (protein C, protein S, antitrombin III, Faktör
V Leiden mutasyonu, homosistein düzeyi, protrombin 20210 A
mutasyonu, faktör düzeyleri) ve orak hücreli anemiye yönelik
incelemelerin normal olması ile hematolojik hastalıklar ekarte
edildi. Zeminde atrial fibrilasyon varlığı en güçlü etyolojik faktör
olarak değerlendirildi. Hastaya oksijen, intravenöz hidrasyon
ve düşük molekül ağırlıklı heparin başlandı. Hastanın şikayetleri
azaldı, klinik olarak belirgin düzelme gözlendi.
Sonuç: Karın ağrısının nadir nedenlerinden biri olması ve etyolojik
faktör olarak atrial fibrilasyon dışında patoloji saptanmaması
nedeni ile olgumuzu literatür bilgileri eşliğinde sunduk.
References
- Jaroch TM, A. Broughan T, Hermannn ER: The natural history of splenic infarction. Surgery 1986; 100: 743-50.
- Antopolsky M, Hiller N, Salameh S,Goldshtein B, Stalnikowicz R. Splenic infarction: 10 years of experience. Am J Emerg Med 2009; 27: 262-5. [CrossRef]
- Ebert EC, Nagar M, Hagspiel KD. Gastrointestinal and hepatic complications of sickle cell disease. Clin Gastroenterol Hepatol 2010; 8: 483-9. [CrossRef]
- Park MY, Kim JA, Yi SY, Chang SH, Um TH, Lee HR. Splenic infarction in a patient with autoimmune hemolytic anemia and protein C deficiency. Korean J Hematol 2011; 46: 274-8. [CrossRef]
- Görg C, Seifart U, Görg K. Acute, complete splenic infarction in cancer patient is associated with a fatal outcome. Abdomen Imaging 2004; 29: 224-7. [CrossRef]
- Menke J, Luthje L, Kastrup A, Larsen J. Thromboembolism in atrial fibrillation. Am J Cardiol 2010; 105: 502-10. [CrossRef]
- Lawrence YR, Pokroy R, Berlowitz D, et al. Spleni cinfarction: an update on William Osler’s observations. Isr Med Assoc J 2010; 12: 362-5.
- Pachter HL, Hofstetter SR, Elkowitz A. Traumaticcysts of the spleen-the role of cystectomy and splenic preservation: experience with seven consecutive patients. J Trauma Sep 1993; 35: 430-6. [CrossRef]
- Robertson F, Leander P, Ekberg O. Radiology of the spleen. European Radiol 2001; 11: 80-95. [CrossRef]
Abstract
Introduction: Splenic infarct is an unusual altitude. Generally, it arises from hematologic diseases and vascular and thromboembolic disorders.Case Report: A 79-year-old woman was admitted to our clinic with pain of the left upper region, emesis, vomiting, nausea, and cold sweat. The patient took beta-blocker and antiaggregant treatment for hypertension and atrial fibrillation. We detected rapid ventricular response atrial fibrillation on her ECG analysis. Also, abdominal CT was concordant with a splenic infarct. Her coagulation tests and sickle cell anemia tests were normal, which excluded hematological disorders (protein C, protein S, antithrombin III, Factor V Leiden mutation, homocysteine value, prothrombin 20210 A mutation, factor levels). We evaulated important risk factors as etiological causes for atrial fibrillation. Low-molecular-weight heparin (LMWH), oxygen, and intravenous hydration were started in the patient. Her complaints were decreased with time and showed clinical recovery. Conclusion: Our case is very interesting, because there is no frequent splenic infarct coexisting with atrial fibrillation
References
- Jaroch TM, A. Broughan T, Hermannn ER: The natural history of splenic infarction. Surgery 1986; 100: 743-50.
- Antopolsky M, Hiller N, Salameh S,Goldshtein B, Stalnikowicz R. Splenic infarction: 10 years of experience. Am J Emerg Med 2009; 27: 262-5. [CrossRef]
- Ebert EC, Nagar M, Hagspiel KD. Gastrointestinal and hepatic complications of sickle cell disease. Clin Gastroenterol Hepatol 2010; 8: 483-9. [CrossRef]
- Park MY, Kim JA, Yi SY, Chang SH, Um TH, Lee HR. Splenic infarction in a patient with autoimmune hemolytic anemia and protein C deficiency. Korean J Hematol 2011; 46: 274-8. [CrossRef]
- Görg C, Seifart U, Görg K. Acute, complete splenic infarction in cancer patient is associated with a fatal outcome. Abdomen Imaging 2004; 29: 224-7. [CrossRef]
- Menke J, Luthje L, Kastrup A, Larsen J. Thromboembolism in atrial fibrillation. Am J Cardiol 2010; 105: 502-10. [CrossRef]
- Lawrence YR, Pokroy R, Berlowitz D, et al. Spleni cinfarction: an update on William Osler’s observations. Isr Med Assoc J 2010; 12: 362-5.
- Pachter HL, Hofstetter SR, Elkowitz A. Traumaticcysts of the spleen-the role of cystectomy and splenic preservation: experience with seven consecutive patients. J Trauma Sep 1993; 35: 430-6. [CrossRef]
- Robertson F, Leander P, Ekberg O. Radiology of the spleen. European Radiol 2001; 11: 80-95. [CrossRef]
Details
| Other ID | JA32HT96DB |
|---|---|
| Journal Section | Case Report |
| Authors | |
| Publication Date | May 1, 2014 |
| Submission Date | May 1, 2014 |
| Published in Issue | Year 2014 Volume: 5 Issue: 5 |