A 33-year-old woman was referred for abdominal pain.
The patient had a normal pregnancy 4 years prior to admission and had not reported toxic habits or regular medication.
She came to the emergency room for pain in the left hypochondrium for 3 months, intensified in the last 24 hours.
Abdominal perimeter increase and fever of 38.5 oC, without other infectious focus.
He did not report toxic syndrome or intestinal habit alteration.
On physical examination, the patient was conscious, oriented, normohydrated, with a certain degree of skin and mucous membrane tenderness.
TA 140, FC 100 ppm, FR 20 rpm, ta axillary 37.3 oC.
Cardiac and pulmonary consolidation were normal.
The abdomen is blandom, depressible, with the only finding of a hard, painful, 17 cm stenosis.
Peripheral lymphadenopathies and extremities are normal.
Analytically at admission she has 2,900 leukocytes/mm3 (82% N, 14% L), HB 8.2 g%, Hto 26%, VCM 84.8, RDW 17.1, 79.000 cefglycal biochemical ionemia 29, quick
Radiologically, there is an elevation of the two hemidiaphragms without alteration of the pulmonary hilium, and displacement of the intestinal loops by a mass effect in the left hypochondrium.
The patient was admitted to the Hematology Department with diagnosis of splenic enlargement and pancit.
Abdominal ultrasound showed images compatible with multiple splenic intraparenchymal hematomas.
The abdominal CAT scan showed no other findings.
Negative cytogenetic studies, negative viral hepatic serology, negative mantoux, normal hormonal study, normal folic acid metabolites, complete coagulation study without other findings than normal thromboglobin, normal microglobulin% decrease, normal immunoglobulin 18
Tumor markers were negative, as well as screening for occult tumors (bone marrow mammography, genital cytology, bone marrow biopsy).
During this study, a transfusion of 450 cc of leukocyte concentrate was required, with hemodynamically stable, and abdominal pain controlled with first step analgesics.
With the diagnosis of hypercholesterolemia syndrome, we requested to perform a cystectomy, which was performed laparoscopically, without incidents.
The postoperative course was fever, without local or general complications, fever, remission of pain, oral intake and drainage removal.
The anatomopathological report of the specimen showed: splenic peliosis without hyperplasia of the endothelium, with sinus histiocytosis and macrophage cells and hemosiderin crystals.
After one year of follow-up, the woman recovered the normal parameters of the three series without any treatment, with no evidence of complications or liver recurrence.
