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Abstract: Although the patient had mild abdominal pain and chest pain after falling downstairs, he did not pay attention to and treat the problem because he felt that it did not affect his life and work. After the outpatient examination, the patient was admitted to our hospital for treatment of “splenic rupture” and was given an open splenectomy.
Basic information】Female, 55 years old
Disease Type】Spleen rupture (traumatic splenic rupture)
Hospital】The First Affiliated Hospital of Zhengzhou University
Time of consultation】September 2019
Treatment plan】Surgical treatment (laparoscopic exploratory surgery, open suture repair of the spleen)
Treatment Period】1 week of inpatient treatment and regular outpatient review
【Treatment effect】The surgery went well and the ruptured spleen tissue was repaired
I. Initial consultation
The patient had chest pain and abdominal pain on the left side after she fell downstairs two days before, but because she did not have symptoms such as chest tightness, dyspnea, nausea and vomiting, she did not pay attention to them and did not go to the hospital for examination, but just took medication on her own. However, the pain did not decrease after the medication, but increased instead, so he came to our hospital for consultation.
The outpatient examination suggested that the patient had pain on percussion in the liver area, and combined with the patient’s description, he was initially considered to have injury to the splenic organs. After CT examination of the chest and abdomen, the patient was admitted to our hospital with “traumatic splenic rupture” for further treatment, which showed the presence of subperitoneal hematoma of the spleen.
Treatment history
After the patient was admitted to the hospital, the patient was examined, which showed that there was no deformity in the thorax, and the skin of the thorax was intact without obvious trauma. The liver and spleen were not palpable under the ribs, the liver area was percussive, the left side of the abdomen was painful with no rebound pain, the mobile turbid sounds were negative, and the bowel sounds were normal. A CT examination of the chest and abdomen appeared to reveal the presence of a right middle lobe focal lung fibrosis with a subperitoneal hematoma of the spleen and a right abdominal hematoma. The patient was found to have multiple splenic ruptures, and if hemorrhage was not treated early, the patient could easily go into hemorrhagic shock and coma, requiring laparoscopic exploration to determine the specific surgical treatment, such as splenoprotective treatment or total splenectomy. With the exclusion of contraindications to surgery, the patient was given a laparoscopic exploration under general anesthesia, and multiple ruptures of the spleen were found. The decision was made immediately to perform a suture repair of the spleen to repair the ruptured spleen and resolve the bleeding situation.
III. Treatment results
The patient underwent a relatively smooth operation and returned to the ward safely after surgery. After awakening from anesthesia, the patient spoke fluently and thought clearly. On the third postoperative day, the patient was in a good mental state, and there was only a small amount of blood leakage from the wound, and the surgical incision was slightly painful, but generally tolerable. On the 5th postoperative day, the patient’s wound condition was observed, the blood and exudate disappeared, the wound gradually dried up, there was no sign of infection, and the pain at the surgical incision basically disappeared. On the 7th postoperative day, the patient’s pain at the surgical incision disappeared, and he recovered well without other discomfort symptoms.
Two weeks after the operation, the patient came to remove the stitches and saw that the surgical incision was healing well and there was no sign of infection, so he was asked to review the operation regularly. Three months after the operation, the patient could gradually resume daily physical activities. After half a year, the patient underwent a number of examinations and the results were basically in the normal range, which proved that the patient’s condition had been resolved.
IV. Notes
I felt very relieved to see the patient’s symptoms gradually reduced, but I still need to remind the patient to pay attention to some matters after surgery.
1, the patient should be given easily digestible food in the diet, including semi-liquid diet, etc. At the same time, it is necessary to strengthen nutrition appropriately, as well as appropriate intake of food that can replenish blood, such as red dates, lean meat, etc., and avoid eating spicy and stimulating food.
2, closely observe the healing of the patient’s incision, usually 2-3 days need to change the dressing once. If the wound, accompanied by redness, swelling and pain, it is necessary to go to the hospital for timely consultation.
3. Pay more attention to rest on a daily basis, while ensuring sufficient sleep and rest. After the symptoms improve, you can increase exercise to promote recovery and increase your immunity.
V. Personal insight
The spleen is one of the more fragile organs in the human body, so it can be easily damaged or even ruptured after being hit or struck by violence. If the patient has only a minor spleen rupture, there may not be any symptoms in the short term, but as the bleeding from the spleen increases, the patient may experience anemia, dizziness, and abdominal pain, similar to the patient in this case. And once the spleen ruptures, it is likely to lead to abdominal hemorrhage, so patients who have a ruptured spleen need to undergo surgery as soon as possible.