Patient with enigmatic splenic tear

Patient with enigmatic splenic tear


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Patient with enigmatic splenic tear
23.11.2014

A 61-year-old Japanese went to a hospital in Tokyo after three weeks of tiredness and mild fever, apparently just in time. Because during the examination, the doctors immediately noticed the greatly enlarged spleen of the man. Nevertheless, the doctors around Kensuke Adachi from the Tokyo Metropolitan Tama Medical Center were initially unable to make an exact diagnosis.

The causes of such an enlargement can be varied in nature, ranging from infectious diseases to spleen cancer. Such a causative cancer (lymph gland cancer, sarcoma, cancer with metastasis) in turn causes noticeable symptoms. Malignant lymphomas, for example, can be accompanied by swelling of the lymph nodes, chronic fatigue, loss of appetite, night sweats and an increased susceptibility to infection. However, none of these symptoms is a reliable indicator because they can also occur in connection with numerous other diseases. "In the further course of the disease, those affected often suffer from complaints caused by the pressure on the surrounding tissue structures and organs due to the tumorous enlargement of the spleen. Above all, this can lead to abdominal pain, a feeling of pressure in the abdomen, nausea or even radiating pain the left shoulder. "

However, laboratory examinations did not help the man, and a CT scan, apart from confirming that the spleen was greatly enlarged, did not provide any new findings, as did an examination of the bone marrow, lungs and mucosa.

Pain Shortly After CT However, shortly after this examination, the patient began to cough and complained of pain in the abdomen and left shoulder. In addition, his circulation broke down and the hemoglobin level in the blood dropped significantly, so that he was examined again in the CT. The treating doctors discovered a splenic tear, which explained the pain in the left shoulder and made emergency surgery absolutely necessary. During the operation, the man's spleen was then completely removed and three liters of blood were taken from the abdominal cavity.

However, such an intervention also harbors inherent dangers: those affected can continue to live without a spleen, but they are subject to certain risks, such as an increased susceptibility to infection with certain bacteria, which can cause pneumonia, meningitis, otitis media and sinus infections. Furthermore, the risk of thrombosis increases after a so-called splenectomy. Nevertheless, splenectomy is a very common measure that serves to achieve a maximum reduction in tumor tissue and thus increase the chances of successful treatment.

As it turned out, the intervention was urgently needed in the case of the Japanese, because the male organ removed was almost twice as large as normal and, on a pathological examination, the doctors found what was known as non-Hodgkin's lymphoma, a cancer. Further tests confirmed the diagnosis.

After two months of regeneration, chemotherapy and vaccination, and extensive antibiotic supply, the man's blood values ​​are now back to normal. He no longer has lymphoma and is not infected with an infectious disease. (sb)

Image: Christoph Droste / pixelio.de

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