No abstract
STUDIES of the blood-platelets after splenectomy for the rupture of an otherwise normal spleen are sufficiently rare to warrant the report of the following case.CASE REPORT.-The patient, a boy eleven years of age, was injured about eight o'clock in the evening by an automobile, which struck him on the right side and knocked him to the pavement. He was not unconscious and was able to rise unassisted to his hands and knees. There was no nausea or vomiting. He was somewhat disoriented. He was brought direct to the Vanderbilt Clinic and was transferred to the Babies Hospital two hours later. By this time he had vomited and was showing signs of shock. Shortly after his admission to the hospital he was given an infusion of 300 cubic centimetres of io per cent. glucose which improved his condition temporarily. At midnight, four hours after his injury, he began to vomit blood and by this time showed all the classical signs of hiemorrhage.Examination showed contusions about the face and definite evidences of a fracture through the right ramus of the mandible. The left hip and thigh were also bruised. The abdomen was soft and relaxed and no tenderness, spasm, or shifting dullness could be elicited. As he was obviously in shock from loss of blood and fluoroscopical examination of the chest had eliminated haemorrhage into the pleural cavity, the diagnosis of a ruptured intra-abdominal viscus with secondary hoemorrhage was made. The only localizing symptom was the vomiting of blood, which is commonly seen in traumatic rupture of the spleen.Operationt.-He was transfused with 400 cubic centimetres of whole blood and immediately afterward the abdomen was opened under local anaesthesia through a left rectus incision. The peritoneal cavity was completely filled with fresh and partly changed blood which welled up into the wound as rapidly as the field was dried. Open ether anmesthesia was begun at this point. Exploration showed all of the tissues in the left side of the abdomen including the mesocolon to be suffused with extravasated blood. The spleen was identified and a large rent was felt across its convex surface. The splenic pedicle was grasped between the index and middle fingers of the left hand, a clamp was placed distal to this, the pedicle was divided and the spleen removed. The pedicle was ligated with a transfixion suture of plain catgut; several other bleeding vessels were ligated and the splenic bed was left dry. The abdomen was closed in layers without drainage. The patient made a satisfactory post-operative recovery, his temperature being normal on the fourth day after operation. He was discharged from the hospital on the seventeenth post-operative day.Pathological Report.-Examination of the spleen showed a tear on the diaphragmatic surface five centimetres long which extended through the underlying parenchyma to the visceral surface of the organ. On the latter surface there was another tear four centimetres long which was continuous with the one just described. Microscopical examination showed normal splenic tissue.
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