05 May 2014 : Case report
Spontaneous non-traumatic massive intraabdominal spleen bleeding in young females: Importance of ATLS principles and trauma alarm
Management of emergency care, Rare diseaseAirazat M. KazaryanABCDEF, Joachim WiborgABCDEF, Kristin HaussBCDEF, Tommy K. AnundsenBCDE, Olav J. FlemmenCDEF, Thor Erik HolmCDEF, Giedrius LauzikasABCDE
Am J Case Rep 2014; 15:189-193
BACKGROUND: ATLS principles have become a standard of care for trauma patients. However, there is poor documentation in regard to spontaneous non-traumatic life-threatening bleedings.
CASE REPORT: Two women, a 21-year-old and a 28-year-old, presented to the admissions department in hemorrhagic shock. The latter woman was in her 26th week of pregnancy. The trauma alarm was raised and the patients received prompt, complex diagnostics including ultrasonography verifying massive intraabdominal fluid. Massive infusion therapy was initiated. The first patient was intubated in the emergency room and required cardiopulmonary rescue due to cardiopulmonary arrest. The patients were moved to the surgical theatre for life-saving operations at 30 and 60 minutes, respectively, after arrival in the emergency department. In the first case, we found 4 L of intraabdominal blood and a rupture in the lower pole of the splenic capsule. Splenectomy was performed. The patient developed disseminated intravascular coagulation syndrome and was transferred to a first-level trauma centre for further treatment. She survived with slight sequelae in the form of psychosocial maladjustment, and low-grade spasms and myoclonic twitches due to prolonged brain ischemia. She was steadily improving at 17 months of follow-up. Viral mononucleosis was established as the cause of the spontaneous rupture of the spleen. In the second case, we found 2.5 L of intraabdominal blood and persistent bleeding from an aneurism of the splenic artery. A splenectomy was performed. She was transferred to a first-level trauma centre for further treatment. She lost the fetus and underwent autotransplantation of the right kidney after 3 months, due to the finding of an aneurism of the right renal artery on the abdominal CT. We also found an ectasia in the ascending aorta, which will require follow-up. The patient does not have any other sequelae and has made a complete recovery at 12 months of follow-up.
CONCLUSIONS: ATLS principles and trauma alarm readiness play a major role in lifesaving surgery in patients with non-traumatic hemorrhagic shock.
Keywords: Advanced Trauma Life Support Care, Aneurysm, Ruptured, Shock, Hemorrhagic, Splenectomy
19 May 2022 : Case reportBilateral Emphysematous Pyelonephritis Associated with COVID Pneumonia: A Case Report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936370
17 May 2022 : Case reportHigh-Frequency Oscillatory Ventilation for Refractory Hypoxemia in Severe COVID-19 Pneumonia: A Small Case ...
Am J Case Rep In Press; DOI: 10.12659/AJCR.936651
13 May 2022 : Case reportA case of exacerbation of haloperidol-induced rhabdomyolysis following the onset of COVID-19
Am J Case Rep In Press; DOI: 10.12659/AJCR.936589
20 May 2022 : Case reportDiagnostic Puzzle of Acute Ischemic Stroke Mimics – Seizure Versus Post-Stroke Recrudescence: A Case Report
Am J Case Rep In Press; DOI: 10.12659/AJCR.936826
19 May 2022 : Case reportExtremes of Anemia: The Lowest Hemoglobin Values Probably Ever Reported in the Pediatric Literature Attribu...
Am J Case Rep In Press; DOI: 10.12659/AJCR.936252
19 May 2022 : Case reportAcute Hepatitis with Positive Autoantibodies: A Case of Natalizumab-Induced Early-Onset Liver Injury
Am J Case Rep In Press; DOI: 10.12659/AJCR.936318
Most Viewed Current Articles
31 Dec 1969 : Case reportPenile Necrosis Associated with Local Intravenous Injection of Cocaine
Am J Case Rep 2022; 23:e935250
31 Dec 1969 : Case reportMyocarditis, Pulmonary Hemorrhage, and Extensive Myositis with Rhabdomyolysis 12 Days After First Dose of P...
Am J Case Rep 2022; 23:e934399
31 Dec 1969 : Case reportLipedema Can Be Treated Non-Surgically: A Report of 5 Cases
Am J Case Rep 2021; 22:e934406