Air in the Spleen
Simon De Freitas, Evan G. Wong
N Engl J Med 2019; 381:566
DOI: 10.1056/NEJMicm1817266
A 56-year-old woman presented to the emergency department with a 1-month history of epigastric and left-upper-quadrant abdominal pain. Her medical history included polysubstance use disorder (including cocaine and heroin use) and hepatitis C virus infection, as well as rheumatoid arthritis, for which she had been taking naproxen. On the day after admission to the hospital, the patient had acute worsening of the abdominal pain. She had new abdominal tenderness on physical examination, including involuntary guarding and rebound tenderness. Computed tomography of the abdomen revealed extensive air in the spleen, as well as intraperitoneal free air. The patient underwent exploratory laparotomy, during which an ulcer measuring 2 cm in diameter was identified on the greater curvature of the stomach, with fistulization into the spleen. A splenectomy and gastric wedge resection were performed. Histologic examination confirmed a diagnosis of peptic ulcer disease. On follow-up 10 weeks later, the patient had recovered from the surgery and had no abdominal pain.
一名56岁女性患者因中上腹及左上腹疼痛一个月到急诊就诊。既往病史包括多种药物（包括可卡因和海洛因）吸毒及丙型肝炎病毒感染，类风湿关节炎（服用萘普生）。入院后一天，患者出现腹痛加重。体格检查发现新出现的腹部压痛，肌卫及反跳痛。腹部CT扫描显示脾脏广泛气体分布，同时还有腹膜后游离气体。患者接受了剖腹探查手术，期间发现胃大弯处直径2 cm的溃疡破入脾脏。遂行脾脏切除术及胃楔形切除。组织病理检查确诊为消化性溃疡。10周后进行随访，患者情况恢复良好，腹痛完全消失。
