Sickle Cell Disease, Spleen Infarction vs. Intermittent Ureteropelvic Junction Obstruction
Left picture: The diagnosis is an acute episode of spleen infarction in a homozygous type of sickle cell disease. The punctuated white discoloration are sequels of former infarctions. Given the actual migration quote, a sickle cell disease must also be considered in the differential diagnosis of a surgical abdomen. The infarctions may involve all organs; therefore, also in acute respiratory symptoms, hematuria or pain in the extremities, the diagnosis of a sickle cell disease is possible. In case of repeated spleen infarctions with threatening surgical abdomen, anemia and thrombocytemia, a splenectomy must be performed. Right picture: On the occasion of an ultrasound and subsequent IVU following fluid load, the cause of the surgical abdomen could be determined to be an intermittent ureteropelvic junction obstruction of the left side. Compare the picture at the bottom with the initial IVU in the picture at the top. The case illustrates that the differential diagnosis of a surgical abdomen includes also retroperitoneal pathologies, such as obstructive uropathies, nephrolithiasis and other diseases.
Left picture: Operative findings in a teenager who was admitted to the emergency department as surgical abdomen with left-sided colics. The history obtained with the aid of an interpreter tells that the girl had repeated episodes of severe left upper abdominal pain. The spleen is large and exhibits multiple white scattered deposits. Do the operative findings explain the abdominal emergency? Right picture: IVU of a female toddler who was admitted to the emergency department two days ago. The mother had already consulted the emergency department several times: During the abdominal colics combined with vomiting, which the mother described as dramatic, the girl was lying in a bent position in bed and was motionless. The IVU shows an ampullar renal pelvis on both sides, and no findings of an obstructive uropathy or a nephrolithiasis. From what pathology does the child suffer?