부산대학교 도서관

The splenic rupture is one of the major causes of hemorrhagic shock with great mortality even in the case of early diagnosis and proper treatment. We present here the case of a patient aged 84 years who came to the intensive care unit of 'Sf. Ioan' Clinical Emergency Hospital from Bucharest with an unspecific clinical presentation: confusion, agitation, tachycardia, hypotension and presenting Livedo reticularis. The paraclinical investigations revealed critical condition on arrival: hypochromic microcytic anemia with 7.2 g/dL hemoglobin. Thorax, abdomen and pelvis computed tomography (CT) scan revealed dense, perihepatic, perigastric, interhepatogastric and perisplenic accumulations, suggesting hemoperitoneum. Shortly after the arrival, the patient suffered a cardiopulmonary arrest responsive to resuscitation procedures. Based on these findings the patient was submitted to exploring laparotomy. Peritoneal cavity exploration revealed: hemoperitoneum through splenic rupture in 2 sites and gastric infarction with an almost-total necrosis. Taking into account the hemodynamic instability, damage control was decided as the best approach. Therefore, splenectomy, subtotal gastrectomy and feeding jejunostomy were performed, ensuring this way the control of lesions and the stabilization of the patient in the intensive care unit (ICU). Soon after admission and surgical intervention the patient was found to be positive for SARS-CoV-2. The postoperative course of the patient was unfavorable as the patient died from a heart attack unresponsive to resuscitation. Overall, it is important to bear in mind that although gastric infarction is a rare event, it is accompanied by great morbidity and mortality. Despite that only few cases of gastric infarction are reported in literature, this diagnosis must be taken into consideration, especially in SARS-COV-2 positive patients or history of recent COVID-19. [ABSTRACT FROM AUTHOR]