Ruptura slezene u trudnoći

master's thesis

• Title (english): Splenic rupture in pregnancy
• Author: Dajana Deak
• Mentor: Goran Augustin (mentor)
• Committee member: Mate Majerović (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Goran Augustin (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2015-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Ruptura slezene u trudnoći je rijedak entitet. Prema uzroku, ruptura se može podijeliti na traumatsku rupturu, spontanu rupturu, rupturu povezanu s toksemijom u trudnoći te na rupturu koja nastaje u patološki promijenjenoj slezeni. Patološka stanja slezene mogu uključivati torziju slezene, aneurizme lijenalne arterije ili lijenalne vene te ektopičnu trudnoću s mjestom implantacije u tkivu slezene. Nabrojena stanja te već spomenuta trauma, koja može biti različitog intenziteta, uvelike doprinose razvoju rupture slezene. Spontana ruptura smatra se najrjeđom od svi ruptura. U kliničkoj prezentaciji znakovi i simptomi koji se najčešće javljaju jesu bol u abdomenu, osjetljivost na palpaciju te simptomi hemodinamskog šoka ukoliko je došlo do masivnog krvarenja u intraperitonealnu šupljinu. Postoji velika opasnost da se ti znakovi i simptomi pripišu raznim opstetričkim komplikacijama ovisno o tome u kojem se tromjesečju trudnoće dogodi ruptura slezene. Najčešće primjenjivane metode za postavljanje dijagnoze, ovisno o indikaciji, jesu ultrazvuk, kompjuterizirana tomografija, magnetska rezonanca, angiografija te laparoskopija. Dijagnostička laparoskopija nam može biti osobito korisna ako drugim metodama nismo uspjeli preoperativno postaviti dijagnozu te ako se radi o hemodinamski nestabilnoj pacijentici. Još jedna od prednosti dijagnostičke laparoskopije jest ta da nakon eksploracije abdomena i utvrđivanja potrebe za intervencijom, ona može poslužiti i kao terapija. Ukoliko se pokaže potreba, moguća je i konverzija laparoskopije u laparotomiju. Najčešći oblik liječenja rupture slezene jest kirurško liječenje. Operacija koja se u većini slučajeva izvodi jest splenektomija. Prva splenektomija zbog rupture slezene u trudnoći izvedena je 1898. godine. Rano postavljanje dijagnoze te rano kirurško liječenje uvelike doprinose boljem ishodu u preživljavanju majke i fetusa.

Abstract (english)

Splenic rupture in pregnancy is a rare entity. According to the cause, it may be classified as traumatic rupture, spontaneous rupture, rupture associated with toxemia of pregnancy and rupture following antecedent disease of the spleen. Some of the pathological entities are splenic torsion, splenic artery or vein aneurysm, or splenic pregnancy. All of the former conditions, including the trauma of varying intensity contribute splenic rupture. Spontaneous rupture is the rarest entity. Clinical signs and symptoms are abdominal pain, tenderness and symptoms of hemodynamic shock if massive intraperitoneal bleeding occurs. The most significant pitfalls are ascription of former symptoms to various obstetrics complications depending on the pregnancy trimester in which splenic rupture occurs. For diagnostic purposes, we use various methods such as the ultrasound, CT, MRI, angiography, and laparoscopy. Diagnostic laparoscopy is of great importance in cases with doubtful preoperative diagnosis or in patients in the state of hemodynamic shock. Additional benefits of the diagnostic laparoscopy are that it can also be considered as a therapy procedure after abdominal exploration and affirmation of the proceeding procedures. If is necessary, laparoscopy can be converted to laparotomy. Treatment is mainly surgical. The most usual procedure is splenectomy. Splenectomy for ruptured spleen in pregnancy was first performed in 1898. Early diagnostic and surgical intervention are of the most importance in maternal and fetal survival rate.

• Keywords: slezena; ruptura; aneurizma; laparoskopija; splenektomija
• Keywords (english): spleen; rupture; aneurism; laparoscopy; splenectomy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:382866
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2016-04-01 11:18:42