Portal hipertansiyon ve splenomegali olan bir hastada dalak travması: Olgu sunumu

Abstract

Dalak, künt abdominal travma vakalarının en sık yaralanan organıdır. Son zamanlarda künt dalak yaralanmaları olan yetişkinlerin %50-80'i ameliyatsız olarak tedavi edilmektedir. Bu raporda, portal hipertansiyon ve splenomegali öyküsü olan künt bir abdominal travma hastası sunuyoruz. Grade 3 ve hatta grade 4 dalak yaralanmalarında, mevcut literatürde non-operatif tedavi tavsiye edilmektedir. Splenomegali ve portal hipertansiyon öyküsüne sahip bir hasta ile dalak travması yönetimi literatürde yeterince tartışılmamaktadır. Sunulan olguda, hipersplenizm ve portal hipertansiyon hemostaz üzerindeki etkileri görülmektedir. Masif resusitasyon ile bile, beş saat sonra trombosit seviyesi 40.000/mm³’e azalmıştır. Ancak, bu durumda non-operatif tedavide ısrar etmek ölümcül olabilir.

Keywords

• Dalak travması,Splenomegali

Splenic trauma in a patient with portal hypertension and splenomegaly: A case report

Abstract

The spleen is the most commonly injured organ in cases of blunt abdominal trauma. Currently, 50-80% of adults with blunt splenic injuries are treated nonoperatively. In this report, we present a blunt abdominal trauma patient having a history of portal hypertension and splenomegaly. In grade 3 and even grade 4 splenic injuries non-operative treatment is recommended in current literature. Management of splenic trauma with a patient with history of splenomegaly and portal hypertension is insufficiently discussed in literature. In presented case, hypersplenism and portal hypertension were burden on hemostasis. Even with massive resuscitation, thrombocyte level decreased to 40.000/mm³ after five hours. But, insistence on non-operative treatment in this situation could be fatal.  

Keywords

• Splenic trauma,Splenomegaly

References

1. 1. Sartorelli KH, F rumiento C, Rogers FB, e t al. Nonoperative management of hepatic, splenic, and renal injuries in adults with multiple injuries. J Trauma 2000;49:56–61.
2. 2. Dent D, A lsabrook G, Erickson BA, e t al. Blunt splenic injuries: high nonoperative management rate can be achieved with selective embolization. J Trauma 2004;56:1063–1067.
3. 3. Richardson JD . Changes in the management of injuries to the liver and spleen. J Am Coll Surg 2005;200:648–669.
4. 4. Galvan DA, Peitzman AB . Failure of nonoperative management of abdominal solid organ injuries. Curr Opin Crit Care 2006;12:590–594.
5. 5. Sugawara Y, Y amamoto J, Shimada K, e t al. Splenectomy in patients with hepatocellular carcinoma and hypersplenism. J Am Coll Surg 2000;190:446–450.
6. 6. Rutledge R . The increasing frequency of nonoperative management of patients with liver and spleen injuries . Adv Surgery 1997;30:385–415.
7. 7. Velmahos GC, T outouzas KG, Radin R, e t al. Nonoperative treatment of blunt injury to solid abdominal organs: a prospective study. Arch Surg 2003;138:844–51.
8. 8. Haan JM, B ochicchio GV, Kramer N, e t al. Nonoperative management of blunt splenic injury: a 5-year experience. J Trauma 2005;58:492–498.

9. 9. Stein DM, Scalea TM . Nonoperative management of spleen and liver injuries. J Intensive Care Med 2006;21:296–304.
10. 10. Maddrey WC . Alcohol-induced liver disease. Clin Liver Dis 2000;4:115–131.
11. 11. Lauer GM, Walker BD . Hepatitis C virus infection. N Engl J Med 2001;345:41–52 .
12. 12. Alter HJ, Seeff LB . Recovery, persistence, and sequelae in hepatitis C virus infection: a perspective on long-term outcome. Semin Liver Dis 2000;20:17–35.
13. 13. Fang JF, C hen RJ, Lin BC, e t al. L iver cirrhosis: an unfavorable factor for nonoperative management of blunt splenic injury. J Trauma 2003;54:1131 –1136.
14. 14. Matar HE, Elmetwally AS, Nair MS, Borgstein R, Oluwajobi O. Traumatic splenectomy in a cirrhotic patient with hepatitis C and alcoholic liver disease. BMJ Case Rep 2012;2012.