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    Clinical Management and Surgical Outcomes of Wandering Spleen with Splenic Torsion in Pediatric Patients: A Case Report
    (Albanian Society for Trauma and Emergency Surgery, 2025-01)
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    Kuci, Saimir
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    Lazar Todorovic
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    Kamilovski, Marijan
    Introduction: Wandering Spleen is a rare condition in which the splenic ligaments are abnormally loose or absent. This makes the Spleen more mobile and increases the risk of torsion. This case report outlines the clinical presentation and management of a 10-year-old female patient who presented at our clinic with acute abdominal pain, vomiting episodes, and a severe fever. Imaging tests, such as abdominal ultrasonography and computed tomography, confirmed the diagnosis of splenic torsion by showing a hemorrhagic infarction and a large spleen. We performed a splenectomy to remove the damaged organ, a partial omental resection to remove the dead tissue and removed the mesenteric lymph nodes for further pathological examination. After the surgical procedure, the intensive care unit carefully observed the patient and treated her with intravenous electrolyte replacement, broad-spectrum antibiotics, pain management, and measures to prevent thrombosis. This case highlights the critical need for early diagnosis and timely surgical intervention in cases of wandering Spleen to prevent serious complications, including splenic infarction. By presenting this case, we seek to elevate awareness of wandering Spleen among healthcare professionals, mainly within pediatric groups. We emphasize the importance of timely diagnosis and appropriate management to optimize patient outcomes. Conclusion: Early detection and prompt intervention are crucial in preventing severe complications in pediatric patients. This case emphasizes the necessity of rapid diagnosis and increased awareness in clinical practice. Due to the Spleen's impaired viability, a splenectomy was required. Following surgery, we provided comprehensive monitoring and pharmaceutical assistance to control pain, prevent infection, and maintain nutritional stability.
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    Drug-induced vasculitis with multi-organ injury in a splenectomised patient and mycophenolate mofetil therapy – a case report
    (Институт за јавно здравје на Република Македонија = Institute of public health of Republic of Macedonia, 2025-02)
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    Bekjarovski, Niko
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    We present a case with p-ANCA positive general vasculitis and severe multi-organ injury in a splenectomised patient, which developed during ceftriaxone and metamizole administration for treatment of upper respiratory infection. Case report: A middle-aged woman with 400C fever and sore throat got a treatment with IV metamizole and ceftriaxone in a local hospital. She had a post- traumatic splenectomy 5 years ago. After metamizole, during ceftriaxone administration she felt burning in her face, developing red rush which spread over the face and darkened, later extended to her palms and feet. After visiting several clinics, she was referred finally to the University Clinic for Toxicology in Skopje. On admission, she had hypotension, hypoxemia, livid oro-pharynx, necrotic vasculitis with predominant facial distribution and unpalpable purpura on the extremities. The examinations revealed high levels of inflammatory biomarkers, anaemia, polyserositis, acute pancreatitis, hepatomegaly, acute kidney injury, disseminated intravascular coagulation, right eye vitreous haemorrhage and rhabdomyolysis. Microbiological investigations were negative. Immuno-serology showed positive p-ANCA. The acute renal failure and polyserositis resolved under methylprednisolone, meropenem, furosemide, low molecular weight heparin, fresh frozen plasma, and other symptomatic therapy, which decreased the inflammatory biomarkers, but DIC with thrombocytopenia persisted. A skin biopsy finding was inconclusive. After 25 days, the rheumatologist recommended mycophenolate mofetil with prednisolone peroral therapy during two years that resulted in stabilizing the vasculitis. The patient maintained stable after therapy discontinuation. Conclusions: Drug-induced vasculitis has the potential to induce a severe multi-organ injury with life-threatening complications. Mycophenolate mofetil procured a safe and successful treatment of drug-induced vasculitis. Splenectomy may be a potential risk factor for immunomodulated response to drugs and drugs interactions, especially during infections.
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    SPLENECTOMY IN SPORT INJURY OF THE SPLEEN: A CASE REPORT
    (Faculty of Physical Education, Sport and Health in Skopje, Republic of Macedonia, 2016)
    Rexhep Selmani
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    Qemal Rushiti
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    Goran Begovic
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    Blerdi Ziba
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    The spleen is one of the most vascular organs in the body, so any trauma to the spleen can cause fatal injury in just a matter of minutes if not recognized and treated. Among the abdominal injuries on sport activities, one should always consider spleen injuries. In this study we analyze a case of an adult who suffered from splenic laceration, caused from an immediate fall to the ground while playing soccer. He had a severe spleen injury, felt pain in the abdomen, in the left side of the chest and the left side of the arm, accompanied with feeling of dizziness, nausea, vomiting, paleness and dyspnea. After having the results of the abdominal examination, CBC, CT, sonography, a review by a cardiologist, the surgeon decided to perform a splenectomy, which prevented the hemorrhage and the maintained of the hemodynamic stability.
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    LONG-TERM FOLLOW-UP OF ADULT PATIENTS WITH IDIOPATHIC THROMBOCYTOPENIC PURPURA AFTER SPLENECTOMY
    (2011-09)
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    Trpkovska-Terzieva S
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    Latifi A
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    Background: Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disease characterized by isolated thrombocytopenia and the absence of any underlying cause for thrombocytopenia. Corticosteroids are the standard first line treatment for patients with symptomatic disease, but in many cases, steroid tapering or withdrawal is followed by a decrease of platelet count and the need for additional treatment. Splenectomy is still the standard salvage therapy in cases refractory to corticosteroid therapy. Aim: The aim of this study was to evaluate the long-term outcome of splenectomized patients with ITP. Materials and Methods: We retrospectively analyzed medical records of 38 patients with ITP that underwent splenectomy after first-line steroid treatment. All patients were followed for at least one year. Results: According to the results at the time of the last control, 28 patients had complete response (CR), but from those 28 patients only 22(58%) were without therapy and 6(22%) were receiving prednisone, azathioprine or both. These results indicate that only 22/38(58%) of patients had long-lasting CR without therapy, 12 patients (31%) were receiving therapy and 4 patients (11%) had partial response without therapy. Conclusion: In conclusion, splenectomy may be considered as safe and effective treatment for patients with ITP who failed to respond to firs-line treatment with corticosteroids.