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妊娠 7個月에 隨伴한 脾臟破裂의 1例

Repture of the spleen accosiated with 7th month pregnancy

최신의학 1962년 5권 10호 p.73 ~ 75
이선익,
소속 상세정보
이선익 (  ) - 부산대학교 의과대학 산부인과학교실

Abstract


A 40 year-old woman, gravida 1X, para VII, was admitted to the Pusan National University Hospital on Oct. 11, 1960, at 10:00 P.M. with the following history; The last menstrual period was Feb. 24, 1960, expected date of confinement was Dec. 1, 1960.
She had suffered no complaints or symptoms suggestive of any form of toxemia. She was well until 5:00 P.M. the day of admission. At this time while go out in the fore yard, she became head-ache and dizziness and then fall down on the fore yard. She recovered consciousness after 5 min. She was up and suffered abdominal pain especially left upper quadrant region. She was diagnosed as intra-abdominal hemorrhage due to unknown origin by her physician in her admission to hospital at 10:00 P.M. She was performed cesarean section and splenectomy on Oct. 12, 1960 at 12:30 P.M.
There are several points of interest to be noted in this case;
First, would this woman lived if she had not been pregnant?
The accident took place on Oct. it and she was operated on Oct. 12. Was the enlarged uterus able to act as an effective tamponade? We think that by diminishing the size of the peritoneal cavity the splenic venous sinuses were effectively tamponade. Iveneus effectively brought out this point in a paper published 1945.
Second, we think that destruction of the splenic substance was by septic emboli or bacteria and then developed pertioneal bleeding due to weakness of the capsule or trauma.
Third, would purformed cesarean section and splenectomy if she has diagnosed as repture of the spleen by the physician.
Fourth, we think that the fetus may suffer severe cerebral anoxia due to the lowered blood count of the mother but this case w-as died in the uterus.
Fifth, the diagnosis of ruptured spleen in pregnancy is likely to be confused with premature seperation of the placenta, ruptured uterus, ruptured ectopic pregnancy, and rupture of other viscera associated with pregnancy.

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