A 26-year-old woman, born in Ecuador.
It describes episodes of abdominal pain accompanied by anemia, always in places of altitude.
At a height of 2,000 meters, the patient presented general malaise, nausea and pain in the left hypochondrium, and was diagnosed with autoimmune hemolytic anemia.
Three months later she came to the emergency room of our hospital with fever of 38.6 oC, dysuria and pollakiuria.
Examination revealed a blushing and depressible abdomen, painful swelling of about 5 cm. The following tests were performed:
- Computed tomography of the abdomen with oral contrast and v.i.: stenosis of the spleen with massive infarction.
There are no vascular alterations that justify it.
- Analytical: leucocytes 16.900 (82 % PMN), hemoglobin 11.5 g/dl, MCV 84, ADE 18, platelets 52.4000.
- Urine: positive nitrites, leucocytes 5-10/ field, erythrocytes 0-5/ field.
Excessive peripheral blood: marked anisopoikilocytosis, abundant sickle cell disease.
- hemoglobin electrophoresis: Hb A2: 4 %, Hb F: 0 %, Hb S: 41 %, Hb C: 36 %.
He is diagnosed with hemoglobinopathy S and C, with hemolytic crisis and massive splenic infarction in the context of acute pyelonephritis.
Once the episode of acute pyelonephritis is resolved, the patient is discharged following controls by Hematology.
Two weeks later the patient was readmitted for pain in the left hypochondrium and fever of 38oC.
Abdominal ultrasound showed massive splenic infarction with probable superinfection.
Emergency surgery was decided with suspicion of massive superinfected splenic infarction, finding a large spleen adhered to left hepatic lobe, stomach, body and tail of pancreas and dark old abdominal wall, with content.
Standardized surgery is performed.
During the postoperative period, he developed a collection in the surgical bed and a low output pancreatic fistula, which resolved with radiological drainage and octeotride.
Histopathological examination of the surgical specimen revealed a massively necrotic splenic parenchyma with wide areas of consolidation.
