脓毒症合并自发性脾破裂出血1例报告

柳舟; 夏文芳; 詹丽英; 方小雨; 张亮; 詹娜; 禹荣; 黄丽; 朱垒

doi:10.3969/j.issn.1001-5256.2023.08.024

脓毒症合并自发性脾破裂出血1例报告

DOI: 10.3969/j.issn.1001-5256.2023.08.024

柳舟^a,
夏文芳^a,
詹丽英^a, , ,,
方小雨^a,
张亮^b,
詹娜^c,
禹荣^d,
黄丽^d,
朱垒^e

a.
武汉大学人民医院重症医学科，武汉 430060
b.
武汉大学人民医院放射科，武汉 430060
c.
武汉大学人民医院病理科，武汉 430060
d.
武汉大学人民医院消化内科，武汉 430060
e.
武汉大学人民医院肝胆外科，武汉 430060

基金项目:

湖北省重点实验室开放项目 (2021KFY018)

伦理学声明：本例报告已获得患者及患者家属知情同意。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：柳舟、张亮、夏文芳负责课题设计，资料分析，撰写论文；詹丽英负责修改论文；方小雨参与收集数据及修改论文；詹娜负责病理阅片及病理图注；张亮负责影像阅片及影像图注；黄丽、禹荣拟定写作思路，指导撰写文章；朱垒负责外科手术记录及手术图片收集，参与最后定稿。

详细信息

通信作者:
詹丽英，2582062108@qq.com (ORCID: 0000-0002-7368-9932)

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出版历程
- 收稿日期: 2022-11-12
- 录用日期: 2022-12-22
- 出版日期: 2023-08-20

Sepsis with spontaneous splenic rupture and hemorrhage: A case report

a.
Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China
b.
Department of Radiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
c.
Department of Pathology, Renmin Hospital of Wuhan University, Wuhan 430060, China
d.
Department of Gastroenterology, Renmin Hospital of Wuhan University, Wuhan 430060, China
e.
Department of Hepatobiliary Surgery, Renmin Hospital of Wuhan University, Wuhan 430060, China

Research funding:

Key Laboratory Open Project of Hubei Province (2021KFY018)

More Information

Corresponding author: ZHAN Liying, 2582062108@qq.com (ORCID: 0000-0002-7368-9932)

摘要

摘要: 脓毒症所致重症感染往往导致多器官功能不全，如心功能不全、肾功能不全、肝功能损伤、脓毒症脑病、凝血功能障碍等。严重感染不仅导致全身炎症反应风暴，同时可诱发脾脓肿形成，甚至自发性脾破裂出血。自发性脾破裂起病隐匿，症状不典型，通常无明显外伤病史，临床容易漏诊。本例脓毒症患者突发左上腹疼痛、血红蛋白进行性下降，紧急完善腹部CT检查，考虑脾破裂出血。剖腹探查术术中发现腹腔大量积血，脾周血肿明显伴脾脏包膜撕裂，遂行全脾切除术。病理提示：脾脏慢性炎症细胞浸润，考虑脾脓肿伴出血。术后患者血色素平稳，腹痛症状明显好转。
- 脓毒症 /
- 脾破裂 /
- 出血 /
- 金黄色葡萄球菌 /
- 脾切除术
Abstract: Severe infections due to sepsis often result in multi-organ insufficiency, such as cardiac insufficiency, renal insufficiency, hypohepatia, septic encephalopathy, coagulation dysfunction etc. Severe infections not only cause inflammatory storm, but also induce spleen abscess, and even combined with spontaneous splenic rupture hemorrhage. Spontaneous splenic rupture has an insidious onset, usually without a history of trauma, and is easily missed diagnosis. In this case, the patient with sepsis had sudden onset of abdominal pain and progressive decrease in hematocrit, thus the abdominal CT was immediately performed. The perisplenic mixed high-density shadow indicated splenic hemorrhage. After consultation with the department of hepatobiliary surgery, emergency dissection was performed. Splenic hematoma and laceration were found during the operation, thus total splenectomy was conducted. Pathological indicated chronic inflammatory cell infiltration of spleen, spleen abscess with bleeding. After operation, the patient's hematocrit was stable, abdominal pain improved significantly, and he was discharged from hospital after systematic therapy.
- Sepsis /
- Spleen Rupture /
- Hemorrhage /
- Staphylococcus Aureus /
- Splenectomy

HTML全文

图 1 腹部影像

注：a，腹部CT(9/27)：脾脏包膜完整未见明显异常；b，腹部CT(10/26)：脾破裂，脾周血肿、腹腔大量积液(箭头示)；c，腹部CT(11/01)：脾切除术后，脾区少量积血积液。

Figure 1. Abdominal radiography

下载: 全尺寸图片幻灯片

图 2 脾脏大体

注：a，脾脏近脾门处可见一长约3 cm裂口(箭头示)；b，脾膈面的包膜撕裂，破裂口约8 cm×4 cm(箭头示)；c，脾膈面不规则大裂口，长约6 cm，深约2 cm(箭头示)。

Figure 2. General view of spleen

下载: 全尺寸图片幻灯片

图 3 脾脏标本病理

注：a，CD3局灶阳性(免疫组化，×100)；b，CD20片状阳性(免疫组化，×100)；c，脾脏被膜下出血伴大量炎性细胞浸润(HE，×40)；d，脾脏内血管扩张伴炎性细胞浸润(HE，×100)。

Figure 3. Pathology of spleen specimen

下载: 全尺寸图片幻灯片

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