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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Wandering spleen may result from congenital failure of splenic attachments or acquired laxity of attachments due to stretching. The wandering spleen is quite vulnerable to the complication of torsion, which is seen most often as an acute abdominal emergency due to splenic infarction. A more unusual variant is chronic torsion which causes intermittent mild to moderate abdominal pain, gastrointestinal disturbances and, in one case, hypersplenism. A mass has been present in most cases and may be anywhere in the abdomen or pelvis. Splenectomy should be performed for all cases of wandering spleen with or without torsion.
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PMID:Chronic torsion of the spleen. 93 48

Patients with extensive atherosclerosis are at increased risk of developing embolic complications during cardiac catheterization. We describe a 51-year-old man with unstable angina and bilateral leg claudication who developed fever and right upper abdominal pain shortly after cardiac catheterization. Liver-spleen scintigraphy demonstrated a wedge-shaped filling defect compatible with splenic infarction, and serial scans performed over a period of five months showed resolution of this finding. Splenic infarction tends to be under-diagnosed, and physicians should be aware of this potentially serious complication of cardiac catheterization.
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PMID:Splenic infarction: a complication of cardiac catheterization. 139 6

A 43 year-old black man with sickle cell trait documented by hemoglobin electrophoresis presented with severe pleuritic chest pain and hypoxemia three weeks after discharge following abdominal surgery. A pulmonary embolus was diagnosed by angiography and he was treated with heparin; the minimum arterial pO2 was 55 torr while O2 was being administered at a rate of 3 L/min. During this therapy, he developed abdominal pain. Computerized tomography suggested splenic infarction, which was documented by radionuclide liver-spleen scan and magnetic resonance imaging (MRI); the patient's spleen had been normal at exploratory laparotomy three weeks previously. No source for emboli was identified in the deep venous system by MRI. Although splenic infarction has been reported in patients with sickle cell trait at high altitude, this is the first reported case of splenic infarction secondary to the hypoxemia of pulmonary embolism in a patient with sickle cell trait. The spleen is subject to infarction in sickle cell trait because blood flow is slow through a hypoxemic and acidemic environment. The additional hypoxemia due to pulmonary embolism is presumed, in our patient, to have created a local splenic environment which permitted infarction to occur.
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PMID:Pulmonary embolism and splenic infarction in a patient with sickle cell trait. 231 14

Forty splenic infarcts in 23 patients were examined with ultrasound (US). At clinical presentation, splenic infarction was associated with severe left upper quadrant pain (n = 10) or diffuse abdominal pain (n = 4) or was asymptomatic (n = 9). In this retrospective study, predominantly wedge-shaped (n = 17) or round (n = 23), irregularly delineated (n = 33) or smooth (n = 7), hypoechoic (n = 40) and anechoic (n = 5) lesions were found at first examination. During follow-up observation, four patients died because of complications unrelated to infarct, and five patients underwent splenectomy as a consequence of US findings. Expanding intralienal liquefaction, increasing subcapsular hemorrhage, free peritoneal blood (even in spleens shown to have an intact surface at sonography), and flow phenomena in the area of infarction demonstrated at B-mode pulsed Doppler US were identified as infarct-related complications associated with the risk of splenic rupture. Despite the high self-healing tendency in splenic infarction, short-term follow-up with US is recommended for early recognition of these possible complications.
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PMID:Splenic infarction: sonographic patterns, diagnosis, follow-up, and complications. 240 85

Wandering spleen is an uncommon diagnosis and has been rarely described in children. A review of the English literature yielded 35 reported cases in children less than 10 years of age. Eighteen (51%) presented as acute surgical emergencies, only eight of which had the correct diagnosis of pedicle torsion with splenic infarction established preoperatively. Thirteen patients underwent an elective laparotomy, either for chronic symptoms related to their wandering spleen or for an abdominal mass. Of the 13 patients electively managed, nine underwent a splenectomy while five were treated successfully with splenopexy. The remaining four patients were managed conservatively without surgical intervention. In only one third of the patients presenting as acute surgical emergencies was there any history of intermittent abdominal pain or of a previous abdominal mass. No deaths were reported. Males represented 63% of the patients. The occurrence was most common in patients less than 1 year of age, with a 6:1 male predominance in this age category. All acute cases of wandering spleen in which splenic infarction has occurred require splenectomy. However, in patients with chronic symptoms or in whom the diagnosis is made prior to splenic infarction, splenopexy should be the treatment of choice. Past recommendations of splenectomy or conservative nonsurgical management are not indicated. Literature on pediatric wandering spleen is reviewed herein, and a technique for splenopexy using Dexon mesh is described.
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PMID:Pediatric wandering spleen--the case for splenopexy: review of 35 reported cases in the literature. 266 92

We describe a 15-year-old black boy with hemoglobin S-C disease living in Atlanta (altitude 1,034 ft), with no prior history of aircraft or mountain travel, who developed splenic infarction. The clinical picture was characterized by severe left upper quadrant abdominal pain, fever, splenomegaly, and hematologic and scintigraphic evidence of functional asplenia. The diagnosis was suggested by liver/spleen scintigraphy and further confirmed by ultrasonography and computerized tomography (CT) of the spleen. Treatment consisted of analgesics, intravenous fluids, and short-term antibiotic therapy. The child recovered without sequelae.
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PMID:Splenic infarction at low altitude in a child with hemoglobin S-C disease. 304 48

Gaucher's disease involves the liver, the spleen, and the bone. Liver-spleen and bone scintigraphy were used during an 8-yr period to evaluate changes caused by this disease. Patients were investigated with a liver-spleen scan for abdominal pain, mechanical discomfort, enlarged liver or spleen on physical examination, abdominal mass, abnormal liver function tests, and symptoms of hypersplenism. Fourteen liver-spleen scans were performed in nine patients. Liver scintigraphy showed various degrees of enlargement and inhomogeneous uptake. In two patients focal defects were detected. In one, focal defects were due to liver involvement with Gaucher's disease, but in the other they were caused by metastatic pancreatic carcinoma. The study was also useful in detecting splenic infarction and in following enlargement of the spleen after partial splenectomy. The main indication for bone scintigraphy in six patients was bone pain. This was found to be caused by either aseptic necrosis of the head of the femur, bone infarction, pathological fractures, or osteomyelitis. Loosening after total hip replacement was ruled out in three patients and missed in one patient. Scintigraphy appears to be a simple, sensitive test for evaluation of the liver, spleen, and bony skeleton in patients with symptomatic Gaucher's disease.
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PMID:Scintigraphic findings in Gaucher's disease. 376 Sep 80

A 54 year old man, hospitalised for thoraco-abdominal pain resulting from a septicemia which gives positive hemocultures for streptococcus D Bovis, is diagnosed to have a splenic abscess which will require splenectomy. At the same time, an endocarditis develops and gets worse, with auriculo-ventricular blockade and, especially, major aortic insufficiency, which is the cause of death by a brutal and massive pulmonary oedema. In the progression of an endocarditis, the occurrence of a splenic abscess, primary localisation of the initial septicemia or the secondary of an arterial septic embolism, is a rare contingency compared to the frequency of splenomegaly or splenic infarction: less than 2 percent of the cases in the literature. This very atypical and exceptional case serves as a reminder, on the one hand, of the diagnostic inadequacy of echocardiography which cannot visualise vegetation in the course of progressive endocarditis, and, on the other, of the prognostic importance of auriculoventricular blockade in septal and aortic endocardial lesions.
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PMID:[Splenic abscess disclosing endocarditis]. 393 91

We describe two patients with sickle cell disease (SCD) who developed infections situated in the spleen. One patient had a splenic abscess and there was strong clinical evidence for an infected splenic infarct in the second patient. SCD predisposes to splenic infection because of functional hyposplenism, defective phagocyte function and splenic infarction. Splenic infections can occur in patients who might be considered to have an absent spleen and the diagnosis of splenic abscess should be considered in individuals with SCD who present with fever and abdominal pain.
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PMID:Splenic sepsis in sickle cell disease. 801 27

Because of the spleen's extensive collateral circulation, the risk of splenic infarction after splenorenal arterial bypass (SRB) has been considered negligible. We report four patients in whom splenic infarctions developed after SRB. Splenic infarction developed in one patient at the time of SRB, and symptoms of splenic abscess (fever, abdominal pain, and leukocytosis) that proved to be splenic infarctions at laparotomy developed in three patients 2 to 16 days after the operation. Factors possibly contributing to splenic infarction could be determined for three patients. These included interruption of collateral vessels, intraoperative hypotension and disseminated intravascular coagulation, and distal splenic artery ligation. Normal Doppler flow was detected in the splenic parenchyma during test occlusions of the splenic artery before SRB in three patients. Our experience suggests that existing collateral circulation may not always sustain splenic viability after SRB, and some patients may not be suitable candidates for this operation. Factors such as adequacy of inflow, splenic artery length, and risk of perioperative hypotension should be considered.
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PMID:Splenic infarction after splenorenal arterial bypass. 844 59


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