Images in Clinical Medicine: Air in the Spleen

Summary

  • 56yo F
  • c/c
    • 1mo Hx of abd pain
      • epigastric
      • Lt upper quadrant
  • PMH
  • HPI
    • ADM +1d
      • abd pain
  • Ex
    • CT (Abd)
      • air in spleen
      • intraperitoneal free air
    • exploratory laparo
  • Tx
    • splenectormy
    • gastric wedge resection
  • Dx
    • peptic ulcer disease

Further

Terminology

Original

Figure

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.