Share this Article
Lau YZ, Lau YF, Lai KY, Lau CP
Correspondence: Prof Chu Pak Lau, cplau@hkucc.hku.hk
ABSTRACT
A 23-year-old man presented with abdominal pain after suffering blunt trauma caused by a seatbelt injury. His low platelet count of 137 ×109/L was initially attributed to trauma and his underlying hypersplenism due to glucose-6-phosphate dehydrogenase (G6PD) deficiency. Despite conservative management, his platelet count remained persistently reduced even after his haemoglobin and clotting abnormalities were stabilised. After a week, follow-up imaging revealed an incidental finding of a pseudoaneurysm (measuring 9 mm × 8 mm ×10 mm) adjacent to a splenic laceration. The pseudoaneurysm was successfully closed via transcatheter glue embolisation; 20% of the spleen was also embolised. A week later, the platelet count normalised, and the patient was subsequently discharged. This case highlights the pitfalls in the detection of a delayed occurrence of splenic artery pseudoaneurysm after blunt injury via routine delayed phase computed tomography. While splenomegaly in G6PD may be a predisposing factor for injury, a low platelet count should arouse suspicion of internal haemorrhage rather than hypersplenism.
Keywords: G6PD, hypersplenism, splenomegaly, transcatheter embolisation, thrombocytopenia
Singapore Med J 2013; 54(11): e230-232; http://dx.doi.org/10.11622/smedj.2013189
REFERENCES
| 1. Baker KS, Tisnado J, Cho SR, Beachley MC. Splanchnic artery aneurysms and pseudoaneurysms: transcatheter embolization. Radiology 1987; 163:135-9. | ||||
| 2. Tessier DJ, Stone WM, Fowl RJ, et al. Clinical features and management of splenic artery pseudoaneurysm: case series and cumulative review of literature. J Vasc Surg 2003; 38:969-74. http://dx.doi.org/10.1016/S0741-5214(03)00710-9 | ||||
| 3. Wu WC, Chiou YY, Hung HH, et al. Prognostic significance of computed tomography scan-derived splenic volume in hepatocellular carcinoma treated with radiofrequency ablation. J Clin Gastroenterol 2012; 46:789-95. http://dx.doi.org/10.1097/MCG.0b013e31825ceeb5 | ||||
| 4. Schafermeyer R. Pediatric trauma. Emerg Med Clin North Am 1993; 11:187-205. | ||||
| 5. Powell M, Courcoulas A, Gardner M, et al. Management of blunt splenic trauma: significant differences between adults and children. Surgery 1997; 122:654- 60. http://dx.doi.org/10.1016/S0039-6060(97)90070-2 | ||||
| 6. Huang IH, Zuckerman DA, Matthews JB. Occlusion of a giant splenic artery pseudoaneurysm with percutaneous thrombin-collagen injection. J Vasc Surg 2004; 40:574-7. http://dx.doi.org/10.1016/j.jvs.2004.06.020 | ||||
| 7. LiPuma JP, Sachs PB, Sands MJ, Stuhlmiller S, Herbener TE. Angiography/interventional case of the day: splenic artery pseudoaneurysm associated with pancreatitis. AJR Am J Roentgenol 1997; 169:259, 262-3. http://dx.doi.org/10.2214/ajr.169.1.9207539 | ||||
| 8. Moore SW, Guida PM, Schumacher HW. Splenic artery aneurysm. Bull Soc Int Chir 1970; 29:210-8. | ||||
| 9. Arepally A, Dagli M, Hofmann LV, et al. Treatment of splenic artery aneurysm with use of a stent-graft. J Vasc Interv Radiol 2002; 13:631-3. http://dx.doi.org/10.1016/S1051-0443(07)61659-5 | ||||
| 10. Dave SP, Reis ED, Hossain A, et al. Splenic artery aneurysm in the 1990s. Ann Vasc Surg 2000; 14:223-9. http://dx.doi.org/10.1007/s100169910039 | ||||
| 11. Cappellini MD, Fiorelli G. Glucose-6-phosphate dehydrogenase deficiency. Lancet 2008; 371:64-74. http://dx.doi.org/10.1016/S0140-6736(08)60073-2 | ||||
| 12. Glader BE. Glucose-6-phosphate dehydrogenase deficiency and related disorders of hexose monophosphate shunt and glutathione metabolism. In:Wintrobe's Clinical Hematology. 10th ed. Baltimore: Williams & Wilkins; 20 08:1176 -119 0. | ||||
| 13. Hundsdoefer P, Vetter B, Kulozuik AE. Chronic haemolytic anaemia and glucose-6-phosphate dehydrogenase deficiency. Case report and review of the literature. Acta Haematol 2002; 108:102-5. http://dx.doi.org/10.1159/000064749 | ||||
| 14. Hamilton JW, Jone s FG, Mc Mullin MF. Glucose-6-phosphate dehydrogenase Guadalajara–a case of chronic non-spherocyctic haemolytic anaemia responding to splenectomy and the role of splenectomy in this disorder. Hematology 2004; 9:307-9. http://dx.doi.org/10.1080/10245330410001714211 | ||||