Hostname: page-component-54dcc4c588-2bdfx Total loading time: 0 Render date: 2025-10-11T04:47:04.224Z Has data issue: false hasContentIssue false
  • English
  • Français

Unusual case of acute onset abdominal pain: uses and limitations of medical imaging

Published online by Cambridge University Press:  21 May 2015

Glen Bandiera  and
Eric Poulin
Glen Bandiera*
Affiliation:
St. Michael’s Hospital, Toronto, Ont., and Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ont.
Eric Poulin
Affiliation:
St. Michael’s Hospital, Toronto, and Department of Surgery, University of Toronto
*
Department of Emergency Services, St. Michael’s Hospital, 30 Bond St., Toronto ON M5B 1W8; 416 864-5095, fax 416 864-5341, glen.bandiera@utoronto.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

A 28-year-old male with atraumatic abdominal pain and transient hypotension was assessed using bedside emergency department (ED) ultrasonography and contrast enhanced helical computed tomography (CT). Both tests revealed free intraperitoneal fluid, but neither detected a splenic defect. The patient subsequently underwent splenectomy for a ruptured spleen. His serology for typical viral causes was negative. This article discusses spontaneous splenic rupture, the role of imaging in diagnosis, and the limitations of ED ultrasound and contrast enhanced helical CT.

Keywords

abdominal painspleen ruptureultrasoundemergency departmentEpstein–Barr

Information

Type
Case Report • Observations de Cas
Information
Canadian Journal of Emergency Medicine , Volume 5 , Issue 4 , July 2003 , pp. 263 - 267
Copyright
Copyright © Canadian Association of Emergency Physicians 2003

References

1.Jess, P, Bjerregaard, B, Brynitz, S, Holst-Christensen, J, Kalaja, E, Lund-Kristensen, J, et al. Prognosis of acute nonspecific abdominal pain. A prospective study. Am J Surg 1982;144(3):338–40.CrossRefGoogle ScholarPubMed
2.Lukens, TW, Emerman, C, Effron, D.The natural history and clinical findings in undifferentiated abdominal pain. Ann Emerg Med 1993;22(4):690–6.Google Scholar
3.Gore, RM, Miller, FH, Pereles, FS, Yaghmai, V, Berlin, JW.Helical CT in the evaluation of the acute abdomen. AJR Am J Roentgenol 2000;174(4):901–13.Google Scholar
4.King, KE, Wightman, J.Abdominal Pain. In: Marx, J, editor. Rosen’s emergency medicine. 5 ed, vol 1. St. Louis: Mosby; 2002. p. 185–94.Google Scholar
5.Klinkert, P, Kluit, AB, de Vries, AC, Puylaert, JB.Spontaneous rupture of the spleen: role of ultrasound in diagnosis, treatment, and monitoring. Eur J Surg 1999;165(7):712–3.CrossRefGoogle ScholarPubMed
6.Marx, J.Abdominal trauma. In: Marx, JA, editor. Emergency medicine: concepts and clinical practice. Vol 1. Philadelphia: Mosby–Year Book; 2002. p. 415–36.Google Scholar
7.Rodriguez, A, DuPriest, RW Jr, Shatney, CH.Recognition of intra-abdominal injury in blunt trauma victims. A prospective study comparing physical examination with peritoneal lavage. Am Surg 1982;48(9):457–9.Google ScholarPubMed
8.Hoagland, RJ, Henson, HM.Splenic rupture in infectious mononucleosis. Ann Intern Med 1957;46:1184–91.Google ScholarPubMed
9.Rothwell, S, McAuley, D.Spontaneous splenic rupture in infectious mononucleosis. Emerg Med (Fremantle) 2001;13(3):364–6.CrossRefGoogle ScholarPubMed
10.Torricelli, P, Coriani, C, Marchetti, M, Rossi, A, Manenti, A.Spontaneous rupture of the spleen: report of two cases. Abdom Imaging 2001;26(3):290–3.Google Scholar
11.Gupta, R, Singh, G, Bose, SM, Vaiphei, K, Radotra, B.Spontaneous rupture of the amyloid spleen: a report of two cases. J Clin Gastroenterol 1998;26(2):161.CrossRefGoogle Scholar
12.N’Guyen Cat, R, Leynaud, G, Martin, J, Dufour, J, Assadourian, R.Spontaneous rupture of the spleen during chronic pancreatitis. A report on two new cases [Author translation]. Sem Hop 1980;56 (11–12):575–8.Google ScholarPubMed
13.Windham, TC, Risin, SA, Tamm, EP.Spontaneous rupture of a nontraumatic intrasplenic aneurysm. N Engl J Med 2000;342 (26):1999–2000.Google Scholar
14.Sugahara, K, Togashi, H, Aoki, M, Mitsuhashi, H, Matsuo, T, Watanabe, H, et al. Spontaneous splenic rupture in a patient with large hepatocellular carcinoma. Am J Gastroenterol 1999;94(1): 276–8.Google Scholar
15.Redondo, MC, Rios, A, Cohen, R, Ayala, J, Martinez, J, Arellano, G, et al. Hemorrhagic dengue with spontaneous splenic rupture: case report and review. Clin Infect Dis 1997;25(5):1262–3.Google Scholar
16.Asgari, MM, Begos, DG.Spontaneous splenic rupture in infectious mononucleosis: a review. Yale J Biol Med 1997;70(2):175–82.Google ScholarPubMed
17.Ra, B.Spontaneous rupture of the spleen as presenting event in infectious mononucleosis. Scand J Infect Dis 2001;33(11):872–4.Google Scholar
18.Polis, MA, Tenagne, H.Viruses. In: Marx, JA, editor. Emergency medicine: concepts and clinical practice. Vol 2. Philadelphia: Mosby–Year Book; 2002. p. 1812–34.Google Scholar
19.Peters, RM, Gordon, LA.Nonsurgical treatment of splenic hemorrhage in an adult with infectious mononucleosis. Case report and review. Am J Med 1986;80(1):123–5.CrossRefGoogle Scholar
20.McLean, ER Jr, Diehl, W, Edoga, JK, Widmann, WD.Failure of conservative management of splenic rupture in a patient with mononucleosis. J Pediatr Surg 1987;22(11):1034–5.Google Scholar
21.Schwarz, M, Zaidenstein, L, Freud, E, Neuman, M, Ziv, N, Kornreich, L, et al. Spontaneous splenic rupture in infectious mononucleosis: conservative management with gradual percutaneous drainage of a subcapsular hematoma. Pediatr Surg Int 1999;15 (2):139–40.CrossRefGoogle ScholarPubMed
22.Schlager, D, Lazzareschi, G, Whitten, D, Sanders, AB.A prospective study of ultrasonography in the ED by emergency physicians. Am J Emerg Med 1994;12(2):185–9.Google Scholar
23.Kendall, JL, Shimp, RJ.Performance and interpretation of focused right upper quadrant ultrasound by emergency physicians. J Emerg Med 2001;21(1):7–13.CrossRefGoogle ScholarPubMed
24.Kuhn, M, Bonnin, RL, Davey, MJ, Rowland, JL, Langlois, SL.Emergency department ultrasound scanning for abdominal aortic aneurysm: accessible, accurate, and advantageous. Ann Emerg Med 2000;36(3):219–23.CrossRefGoogle ScholarPubMed
25.Mandavia, DP, Aragona, J, Chan, L, Chan, D, Henderson, SO.Ultrasound training for emergency physicians — a prospective study. Acad Emerg Med 2000;7(9):1008–14.Google Scholar
26.Mateer, J, Plummer, D, Heller, M, Olson, D, Jehle, D, Overton, D, et al. Model curriculum for physician training in emergency ultrasonography. Ann Emerg Med 1994;23(1):95–102.CrossRefGoogle ScholarPubMed
27.Morse, JW, Saracino, BS, Melanson, SW, Arcona, S, Heller, MB.Ultrasound interpretation of hydronephrosis is improved by a brief educational intervention. Am J Emerg Med 2000;18(2): 186–8.Google Scholar
28.Shih, CH.Effect of emergency physician-performed pelvic sonography on length of stay in the emergency department. Ann Emerg Med 1997;29(3):348–51; discussion, 352.Google Scholar
29.Boulanger, BR, McLellan, BA, Brenneman, FD, Wherrett, L, Rizoli, SB, Culhane, J, et al. Emergent abdominal sonography as a screening test in a new diagnostic algorithm for blunt trauma. J Trauma 1996;40(6):867–74.Google Scholar
30.Blaivas, M, Theodoro, D, Sierzenski, PR.A study of bedside ocular ultrasonography in the emergency department. Acad Emerg Med 2002;9(8):791–9.CrossRefGoogle ScholarPubMed
31.Miller, AH, Roth, BA, Mills, TJ, Woody, JR, Longmoor, CE, Foster, B.Ultrasound guidance versus the landmark technique for the placement of central venous catheters in the emergency department. Acad Emerg Med 2002;9(8):800–5.CrossRefGoogle ScholarPubMed
32.Moore, CL, Rose, GA, Tayal, VS, Sullivan, DM, Arrowood, JA, Kline, JA.Determination of left ventricular function by emergency physician echocardiography of hypotensive patients. Acad Emerg Med 2002;9(3):186–93.CrossRefGoogle ScholarPubMed
33.Orlinsky, M, Knittel, P, Feit, T, Chan, L, Mandavia, D.The comparative accuracy of radiolucent foreign body detection using ultrasonography. Am J Emerg Med 2000;18(4):401–3.CrossRefGoogle ScholarPubMed
34.Hauser, AM.The emerging role of echocardiography in the emergency department. Ann Emerg Med 1989;18(12):1298–303.Google Scholar
35.Jehle, D, Davis, E, Evans, T, Harchelroad, F, Martin, M, Zaiser, K, et al. Emergency department sonography by emergency physicians. Am J Emerg Med 1989;7(6):605–11.Google Scholar
36.Melanson, SW, Heller, M.The emerging role of bedside ultrasonography in trauma care. Emerg Med Clin North Am 1998;16 (1):165–89.CrossRefGoogle ScholarPubMed
37.Abrams, BJ, Wolfson, AB.Bedside ultrasonography: the utility in emergency medicine. EM Rep 1996;17(15):151–60.Google Scholar
38.Heller, M, Jehle, D.Ultrasound in emergency medicine. Philadelphia: W.B. Saunders; 1995.Google Scholar
39.Simon, BC, Snoey, ER.Ultrasound in emergency and ambulatory medicine. St. Louis: Mosby–Year Book; 1997.Google Scholar
41.Blaivas, M, Quinn, J.Diagnosis of spontaneous splenic rupture with emergency ultrasonography. Ann Emerg Med 1998;32(5): 627–30.Google Scholar
40.Shackford, SR, Rogers, FB, Osler, TM, Trabulsy, ME, Clauss, DW, Vane, DW.Focused abdominal sonogram for trauma: the learning curve of nonradiologist clinicians in detecting hemoperitoneum. J Trauma 1999;46(4):553–62; discussion, 562–4.Google Scholar
42.Ma, OJ, Mateer, JR, Ogata, M, Kefer, MP, Wittmann, D, Aprahamian, C.Prospective analysis of a rapid trauma ultrasound examination performed by emergency physicians. J Trauma 1995; 38(6):879–85.Google ScholarPubMed
43.Shuman, WP.CT of blunt abdominal trauma in adults. Radiology 1997;205(2):297–306.CrossRefGoogle ScholarPubMed
44.Tiling, T, Bouillon, B, Schmid, A.Ultrasound in blunt abdominothoracic trauma. In: Border, AM Jr, Hansen, ST, et al, editors. Blunt multiple trauma: comprehensive pathophysiology and care. New York: Marcel Dekker; 1990. p. 415–33.Google Scholar
45.Frager, D.Intestinal obstruction role of CT. Gastroenterol Clin North Am 2002;31(3):777–99.Google Scholar
46.Frager, D, Baer, JW, Medwid, SW, Rothpearl, A, Bossart, P.Detection of intestinal ischemia in patients with acute small-bowel obstruction due to adhesions or hernia: efficacy of CT. AJR Am J Roentgenol 1996;166(1):67–71.Google Scholar
47.Portis, AJ, Sundaram, CP.Diagnosis and initial management of kidney stones. Am Fam Physician 2001;63(7):1329–38.Google Scholar
48.Weyant, MJ, Barie, PS, Eachempati, SR.Clinical role of noncontrast helical computed tomography in diagnosis of acute appendicitis. Am J Surg 2002;183(1):97–9.CrossRefGoogle ScholarPubMed
49.Shen, SH, Chen, JD, Tiu, CM, Chou, YH, Chang, CY, Yu, C.Colonic diverticulitis diagnosed by computed tomography in the ED. Am J Emerg Med 2002;20(6):551–7.Google Scholar
50.Shams, J, Stein, A, Cooperman, AM.Computed tomography for pancreatic diseases. Surg Clin North Am 2001;81(2):283–306.Google Scholar
51.Rubesin, SE, Scotiniotis, I, Birnbaum, BA, Ginsberg, GG.Radiologic and endoscopic diagnosis of Crohn’s disease. Surg Clin North Am 2001;81(1):39–70, viii.CrossRefGoogle ScholarPubMed
52.Levine, MS, Kong, V, Rubesin, SE, Laufer, I, Herlinger, H.Scirrhous carcinoma of the stomach: radiologic and endoscopic diagnosis. Radiology 1990;175(1):151–4.Google Scholar
53.Greenwald, DA, Brandt, LJ, Reinus, JF.Ischemic bowel disease in the elderly. Gastroenterol Clin North Am 2001;30(2):445–73.CrossRefGoogle ScholarPubMed