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DRS treatment of 11 cases


Department of bleeding, is rare. Subcapsular rupture is relatively common,[link widoczny dla zalogowanych], as the spleen capsule intact, the blood volume in the capsule without the risk of clinical manifestations of intra-abdominal hemorrhage, the situation may remain for several days to several months ranging, but with the continued expansion of hematoma or slightly by external forces, such as patient activity,[link widoczny dla zalogowanych], leaving too hard capsule rupture,[link widoczny dla zalogowanych], it will become true rupture. Rupture and rupture of the central capsule developed from the true rupture, known as clinical or secondary delayed splenic rupture. DRS injured patients had a longer interim period, you can not have any symptoms,[link widoczny dla zalogowanych], or only the upper left abdominal distension and pain, sometimes palpable in the left upper quadrant tenderness of the mass. Such cases are mostly under the capsule of the spleen rupture, hematoma formation of tension; or splenic capsule little cracks, bleeding slowly, as blood coagulation or omental cover the bleeding temporarily, when the hematoma continues to increase tension or breaking the membrane envelope intra-abdominal bleeding is caused by blood clots, in which case more than 2 weeks after the injury occurred. DRS occurred following several possible mechanisms: ① the real DRS: Real abdominal blunt trauma injury to the spleen splenic capsule integrity; subcapsular hemorrhage and hematoma growth after a period of time after the tension large, capsule ruptured intra-abdominal bleeding symptoms appear; ② capsule rupture caused by abdominal trauma. Blood clots incarceration gap, blood clots dissolved within the release of peritoneal bleeding symptoms; ③ splenic capsule tear and omentum wrapped around the organs extrusion gap. Over time, the greater omentum was soaked, intra-abdominal bleeding symptoms appear; ④ traumatic splenic capsule tear, less bleeding, when asked after a period of slow increase after the symptoms of intra-abdominal bleeding; ⑤ splenic subcapsular hematoma in real terms, or after a period of time after the formation of pseudocyst, intra-abdominal hemorrhage caused by rupture. If a clear history of trauma, based on clinical symptoms and signs, combined with auxiliary examination, diagnosis usually is not difficult. But history of trauma is not clear, or a longer incubation period, Guangzhou Pharmaceutical Research 2008, 39 No. 6 despite the rupture of clinical symptoms, offenders are usually misdiagnosed as other diseases. Therefore, in order to avoid misdiagnosis, we can help diagnose the following points: ① of unexplained abdominal pain, peritonitis, particularly those with abdominal hemorrhage or shock, should be routinely asked whether the history of abdominal trauma, or abdominal trauma in the last two time between remission of abdominal pain should be thought of rupture; ② the left upper abdominal trauma, suspected visceral rupture of abdominal pain should be observed in the evolution of 2 weeks, regular measurement of pulse, blood pressure and hemoglobin, red blood cell count; ③ If the patient had left upper quadrant progressive increase of the mass and injury symptoms such as persistent fever should be suspected of delayed rupture, select the relevant supplementary examination (including diagnostic paracentesis, diagnostic peritoneal lavage, ultrasound, x-ray examination, CT examination, laparoscopy, etc.) may be diagnostic. Diagnostic peritoneal lavage in which a high degree of suspicion of cases of splenic rupture is necessary, sensitivity can be as high as 96% to 99%. The first principle of treatment is life-saving, preserving spleen second. Since patients with longer duration of delayed splenic rupture, rupture of a blood clot not easy to remove and mouth bleeding, local tissue edema, adhesions, difficult to repair the line and partial removal of the spleen,[link widoczny dla zalogowanych], the general proposition splenectomy. Therefore, the 8 patients diagnosed with delayed splenic rupture after splenectomy. However, for cases of splenic capsule rupture, due to the contraction of vascular smooth muscle spleen and blood volume reduction and other factors, sometimes using effective non-surgical treatment, are free to stop the bleeding, the serum is absorbed, blood clots machine technology, and then recovered. Non-surgical treatment: ① surgical intensive care unit setting, the absolute bed rest for 1-2 weeks; ② fast, continuous gastrointestinal decompression to relieve abdominal distention and nutritional support; ③ quick to add blood volume to maintain water and electrolyte balance; ④ close observation of vital signs and changes in abdominal signs, dynamic monitoring of hemoglobin, hematocrit and urine output conditions; ⑤ use of hemostatic agents, antibiotics and treatment of associated injury. The group had 2 cases of non-surgical treatment of these were recovered. If the gradual increase in the amount of splenic hemorrhage over the spleen capsule or surrounding tissue adhesion pressure, or blood clots to stop bleeding because of temporary shedding, the blood flow to the abdominal cavity, bleeding started to have symptoms of acute rupture, this time to the switch emergency splenectomy, before they can be more. 1 patient in this group this is the case and transit operations. Delayed splenic rupture if early detection, prompt treatment and proper treatment, can often be cured. Therefore, delayed rupture of spleen in the early diagnosis and early treatment is very important.
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