Managing Splenic Hemorrhage in Elderly Patients with Kidney Issues

Splenic hemorrhage

Hello Dr.
Huang, the patient is a 65-year-old individual with a history of long-term dialysis.
Two months ago, they experienced dizziness and were injured by a motorcycle.
The following day, an orthopedic evaluation diagnosed a mild left-sided rib fracture (fourth rib), which was not clearly visible on X-ray.
The patient began to exhibit symptoms of dizziness, unsteadiness, loss of appetite, and abdominal distension (which occurs even without eating).
A month ago, they were brought to the emergency department in the early morning due to abdominal pain and bloating.
Laboratory tests showed low hemoglobin and oxygen levels, and a CT scan revealed splenomegaly with a diagnosis of internal bleeding.
At that time, the patient was fully conscious.
What would be the general management approach in this situation? Thank you.

Lin R, 30~39 year old female. Ask Date: 2015/10/19

Dr. Huang Zhihui reply Surgery

Please cherish our online medical resources.
When asking the same question, please specify only one physician or nutritionist.
Generally, severe bleeding requires surgical intervention.

Reply Date: 2015/10/19

More Info

Managing splenic hemorrhage in elderly patients, particularly those with underlying kidney issues such as chronic kidney disease (CKD) or those on dialysis, requires a careful and multidisciplinary approach. The case you presented involves a 65-year-old patient who has been on long-term dialysis and has experienced a traumatic injury leading to splenic hemorrhage. Here’s a comprehensive overview of the management strategies and considerations for such a scenario.

Initial Assessment and Stabilization
1. Vital Signs Monitoring: The first step in managing any patient with suspected internal bleeding is to monitor vital signs closely. This includes blood pressure, heart rate, respiratory rate, and oxygen saturation. Any signs of hemodynamic instability (e.g., hypotension, tachycardia) should prompt immediate intervention.

2. Laboratory Tests: Blood tests should be performed to assess hemoglobin levels, hematocrit, and coagulation parameters. Given the patient's history of chronic kidney disease, renal function tests (serum creatinine, electrolytes) should also be monitored closely.

3. Fluid Resuscitation: If the patient shows signs of significant blood loss or hemodynamic instability, intravenous fluids (crystalloids) should be administered to maintain blood pressure and perfusion. In cases of severe hemorrhage, blood transfusions may be necessary to stabilize the patient.

Imaging and Diagnosis
4. CT Scan: A CT scan is essential for confirming the diagnosis of splenic hemorrhage and assessing the extent of the injury. It can also help identify any other potential sources of bleeding or complications such as splenic laceration or hematoma.

Surgical Intervention
5. Surgical Consultation: Given the patient's age and comorbidities, a surgical consultation is crucial. In cases of significant splenic hemorrhage, surgical intervention may be required. Options include:
- Splenectomy: Complete removal of the spleen may be necessary if the hemorrhage is severe and cannot be controlled conservatively.

- Splenic Repair: In some cases, if the injury is not extensive, the spleen may be repaired rather than removed.

6. Non-Operative Management: In stable patients with minor bleeding, non-operative management may be considered. This includes close monitoring and supportive care, especially if the patient is hemodynamically stable and the bleeding is not life-threatening.

Postoperative Care and Monitoring
7. Postoperative Management: If surgery is performed, the patient will require careful monitoring in a postoperative setting. This includes monitoring for signs of infection, bleeding, and ensuring adequate renal function, especially in patients with pre-existing kidney issues.

8. Dialysis Considerations: For patients on dialysis, it is essential to coordinate with nephrology to manage dialysis sessions post-surgery. The timing of dialysis may need to be adjusted based on the patient's hemodynamic status and recovery.

Long-Term Considerations
9. Follow-Up Care: After stabilization and treatment, long-term follow-up is necessary to monitor the patient's recovery, renal function, and any potential complications arising from the splenic hemorrhage or its treatment.

10. Patient Education: Educating the patient and family about the signs of complications, such as infection or further bleeding, is crucial. They should be informed about the importance of follow-up appointments and any lifestyle modifications needed to manage kidney health.

Conclusion
In summary, managing splenic hemorrhage in elderly patients with kidney issues involves a systematic approach that prioritizes stabilization, accurate diagnosis, and appropriate surgical or non-surgical intervention. Given the complexity of the case, a multidisciplinary team involving emergency medicine, surgery, nephrology, and possibly hematology will provide the best outcomes for the patient. It is essential to address both the immediate concerns of hemorrhage and the long-term management of chronic kidney disease to ensure comprehensive care.

Similar Q&A

Managing Cirrhosis: Treatment Options for Low Platelet Count Before Surgery

Hello Dr. Chen: My aunt (age 62) has hepatitis C and cirrhosis. She has experienced symptoms such as hepatic encephalopathy, ascites, esophageal varices, and hematemesis. Currently, she is receiving blood transfusions and platelet transfusions. She was originally scheduled for a ...

Dr. Chen Shidian reply Gastroenterology and Hepatology
Dear Mr. Hsiao-Chu, Splenic artery embolization can lead to necrosis and atrophy of the spleen, but it may have side effects such as fever and pain. Prophylactic antibiotics and patient-controlled analgesia (out-of-pocket expense) can be used, but the appropriateness of these m...

Understanding Blood in Urine and Cognitive Decline in Elderly Patients

My father had a mild stroke about three years ago and has diabetes, which he manages with blood sugar control. Recently, we have noticed (1) a significant decline in his memory and cognitive function, (2) occasional hematuria without pain, and (3) a blood sugar level of 400 mg/dL...

Dr. Liang Yinpan reply Geriatrics
Ms. Luo: Hello! It can be difficult for the elderly to express their discomfort clearly. The possible causes of your father's painless hematuria include: 1. Infection 2. Stones 3. Kidney disease 4. Tumor. I recommend visiting a urologist for a detailed examination to identif...

Understanding Kidney Issues: A Comprehensive Guide for Patients and Families

Hello Doctor, My family member (female, 29 years old) has long-term chronic health issues. She has been diagnosed with refractory epilepsy for 23 years and is currently taking the following medications: Depakote 700mg, Vimpat 100mg, Keppra 1000mg, and Lamictal 30mg. Additionally...

Dr. Wu Hongjie reply Internal Medicine
Hello: Currently, your family member's creatinine levels have returned to normal range. The recent decline in kidney function is likely due to acute kidney injury, but regular monitoring is still necessary. Dietary restrictions are not required at this time. The exact causes...

Managing Hematuria in Dialysis Patients with Polycystic Kidney Disease

Hello Doctor: I am a dialysis patient with polycystic kidney disease. Recently, for the past two weeks, I have been experiencing hematuria, with the blood appearing dark brownish-red. I do not have a fever or body aches. The dialysis center has administered hemostatic injections,...

Dr. Chen Jiansheng reply Urology
Patients undergoing dialysis who present with hematuria may be affected not only by anticoagulants administered during the procedure but also by other factors such as stones, polyps, tumors, or infections. It is recommended to consult a urologist for a thorough examination.