Üçüncü Basamak Bir Üniversite Hastanesinde Atravmatik Dalak Rüptürü ile İlgili On Yıllık Deneyim

Yıl 2025, Cilt: 47 Sayı: 1, 128 - 132, 17.01.2025

Akile Zengin , Mithat Mert Yurdakul , Yavuz Selim Angın , Murat Ulaş

Öz

Bu çalışmada, atravmatik dalak rüptürü (ASR) olan hastalardaki klinik deneyimimizi paylaşmayı amaçlıyoruz. Tüm hastaların kayıtları Ocak 2015'ten Mayıs 2024'e kadar retrospektif olarak incelendi. ASR tanısı konulan 8 hastamız vardı.. Hastaların %62.5'i (n=5) kadındı. Ortanca yaş 52.5 (37-72) yıldı. Üç hastada malignite öyküsü, iki hastada hematolojik hastalık ve üç hastada otoimmün hastalık vardı. İki hasta daha önce karın ameliyatı geçirmişti. İki hastada oral antikoagülan kullanma öyküsü vardı. Semptomların başlangıcı ortanca 16 (1-168) saatti. Üç hastaya Epstein-Barr Virüsü ve Sitomegalovirüs testleri yapıldı ve tümünde sonuç negatifti. Üç hastada bilgisayarlı tomografi ile splenomegali tespit edildi. Bir hastada splenektomiye ek olarak distal pankreatektomi yapılırken, bir diğer hastaya distal pankreatektomi, gastrik wedge rezeksiyon ve packing yapıldı. Operasyon süresi ortanca 122.5 (60-210) dakikaydı. Ortanca hastanede kalış süresi 8.5 (1-41) gündü. Patolojik sonuçlar bir hastada adenokarsinom metastazı (endometriyal kanser nedeniyle) ve bir hastada nekrotizan granülomatöz inflamasyondu (abdominal tüberküloz nedeniyle). Ameliyat sonrası erken komplikasyon sadece bir hastada pankreas fistülü olarak görüldü. Üç hastada mortalite görüldü. Bir hasta postoperatif ikinci saatte hipovolemik şoktan, bir diğeri sepsis nedeniyle ve üçüncüsü subaraknoid kanama nedeniyle öldü. Klinik olarak belirsiz sunumuna rağmen, travma öyküsü olmayan ancak hipovolemik şok, akut karın veya etiyolojisi bilinmeyen karın ağrısı ile gelen hastalarda spontan dalak rüptürü tanısı düşünülmelidir.

Anahtar Kelimeler

akut karın, spontan dalak rüptürü, travmatik olmayan dalak hasarı, intraabdominal kanama

Ten-Year Experience with Atraumatic Splenic Rupture in a Tertiary University Hospital

Öz

In this present study, we aim to share our clinical experience in patients with atraumatic splenic rupture (ASR). The records of all patients were reviewed from January 2015 to May 2024, retrospectively. We had 8 patients diagnosed with ASR. Of the patients 62.5% (n=5) were female. The median age was 52.5 (37-72) years. Three patients had a history of malignancy, two had hematologic disease, and three had autoimmune disease.Two patients had previously undergone abdominal surgery.Two patients had a history of oral anticoagulant use.The median onset of symptoms was 16 (1-168) hours. Splenomegaly was detected in three patients via computed tomography. In one patient, a distal pancreatectomy was performed in addition to splenectomy, while for another patient, distal pancreatectomy, gastric wedge resection, and packing were performed. The median operation time was 122.5 (60-210) min. The median hospital stay was 8.5 (1-41) days. Pathological results showed adenocarcinoma metastasis in one patient (due to endometrial cancer), and necrotising granulomatous inflammation in one patient (due to abdominal tuberculosis). Early postoperative complication was seen only one patient as pancreatic fistula. Mortality occurred in three patients. One patient died in the second postoperative hour from hypovolemic shock, another from sepsis, and the third from a subarachnoid hemorrhage. Despite its clinically vague presentation,the diagnosis of spontaneous splenic rupture should be considered in patients with no history of trauma but who present with hypovolemic shock,acute abdomen or abdominal pain of unknown etiology.

Anahtar Kelimeler

acute abdomen, spontaneus spleen ruptur, nontraumatic splenic damage, intraabdominal hemorrhage

Kaynakça

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