■孤立性脾炎是一种极为罕见的疾病。脾炎与各种感染的关联,药物,和条件有不清楚的意义。我们介绍了过去20年来的3例因骨质疏松导致自发性脾破裂的患者,其中两人患有恶性血液病,提请注意可能的相关性。
方法:一名31岁男性,患有原发性血小板减少和抗磷脂抗体综合征,表现为腹痛和低血压恶化。病人否认有任何创伤。计算机断层扫描显示腹膜和脾破裂,并伴有无数充血的脾囊肿。进行了简单的急诊开放性脾切除术,并进行了血液回输。患者在术后第5天出院。该患者发展为急性骨髓性白血病,并在六年后死亡。一名44岁的其他健康男性出现左上象限和肩部疼痛,没有报告创伤。计算机断层扫描(CT)成像显示脾肿大,多发性脾脏囊性病变,和游离的腹腔血液.腹腔镜脾切除术,并发胰腺漏,用排水管管理,已执行。患者在术后第3天出院,随访37个月,情况良好。一名78岁的男性,因华法林治疗心房颤动而出现脾肿大和慢性贫血,从站立高处跌落后出现腹部扩张的休克。患者用两个单位的充血红细胞复苏,并进行了紧急腹部探查。脾脏破裂。进行了开放性脾切除术,并抽出了4升腹膜内血液。病理证实脾炎和既往弥漫性大B细胞淋巴瘤。患者对化疗反应良好,但12年后死亡。
■脾炎是一种病因不明的罕见血管现象。几种有毒药物和药物与石斑病患者的自发性脾破裂有关。还有一些报告的患者被发现患有血液系统疾病,提示与骨质疏松的病理生理学潜在关联。
结论:根据我们的临床经验和重点文献综述,脾炎和血液系统恶性肿瘤之间似乎有一定的关系。
UNASSIGNED: Isolated splenic peliosis is an extremely rare condition. The associations of splenic peliosis with various infections, medications, and conditions have unclear significance. We present three patients from the past twenty years with spontaneous splenic rupture due to peliosis, two of whom had hematologic malignancy, to draw attention to a possible correlation.
METHODS: A 31-year-old male with essential thrombocytopenia and antiphospholipid-antibody syndrome presented with worsening abdominal pain and hypotension. The patient denied any trauma. Computed-tomography demonstrated hemoperitoneum and splenic rupture with innumerable blood-filled splenic cysts. An uncomplicated emergency open splenectomy was performed with shed-blood reinfusion. The patient was discharged on postoperative day five. The patient developed acute myelogenous leukemia and died six years later. A 44-year-old otherwise healthy male presented with left upper-quadrant and shoulder pain without reported trauma. Computed-tomography (CT) imaging revealed splenomegaly, multiple splenic cystic lesions, and free intraperitoneal blood. A laparoscopic splenectomy, complicated by a pancreatic leak that was managed with a drain, was performed. The patient was discharged on postoperative day three and was well at 37 months follow-up. A 78-year-old male with splenomegaly and chronic anemia on warfarin for atrial fibrillation presented in shock with a distended abdomen after falling from a standing height. The patient was resuscitated with two units of packed red blood cells and underwent emergent abdominal exploration. The spleen was ruptured. An open splenectomy was performed and four liters of intraperitoneal blood were evacuated. Pathology confirmed splenic peliosis and historic diffuse large B-cell lymphoma. The patient had an excellent response to chemotherapy but died 12 years later.
UNASSIGNED: Splenic peliosis is a rare vascular phenomenon of unclear etiology. Several toxic and pharmaceutical agents have been associated with spontaneous splenic rupture in patients with peliosis. There are also a number of reported patients who were noted to have hematologic disorders, suggestive of a potential association to the pathophysiology of peliosis.
CONCLUSIONS: Based on our clinical experience and focused literature
review, it appears likely that there is a relationship between splenic peliosis and hematologic malignancy.