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Главная Статьи ПОВРЕЖДЕНИЕ СЕЛЕЗЕНКИ КАК ОСЛОЖНЕНИЕ
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Скрининговая колоноскопия — это стандартная процедура, которая проводится как в стационаре, так и в специализированных амбулаторных отделениях. Частота серьезных осложнений невысока и составляет не более 3 случаев на 1000 обследований. Наиболее частые осложнения после процедуры — перфорация и кровотечение. Повреждение селезенки — редкое осложнение с неизвестной частотой возникновения.

Повреждение селезенки после колоноскопии впервые было зарегистрировано и описано в 1974 году. Это жизнеугрожающее состояние, чаще всего требующее оперативного вмешательства — спленэктомии.

Американские врачи сообщают[1] о травме селезенки у здоровой 59-летней женщины в результате скрининговой колоноскопии после стандартной подготовки в условиях седации.

Ранее женщина перенесла несколько операций — холецистэктомию, два кесаревых сечения и гистерэктомию. В ходе колоноскопии патологий не было обнаружено, процедура прошла без особенностей. Приблизительно через 3 часа после исследования у пациентки появились острые боли в левом подреберье с иррадиацией в левое плечо. Боли в течение дня усиливались, возникло головокружение, общее состояние было предобморочным, что потребовало ее госпитализации.

При поступлении в стационар у пациентки отмечена гипотония — АД 73/38 мм рт. ст., ЧСС 75 ударов в минуту, уровень гемоглобина составлял 101 г/л. При РКТ органов брюшной полости выявлена гематома в области селезенки размером до 4 см (рис. 1). Поскольку экстравазация отсутствовала, было принято решение о консервативной терапии. В ходе лечения отмечалось снижение уровня гемоглобина до 73 г/л, что потребовало гемотрансфузии. Через 7 суток пациентка была выписана из стационара.

Еще через месяц женщина снова была госпитализирована с жалобами на одышку и боли в грудной клетке слева. Симптомы возникли через 2 недели после выписки из стационара. При рентгенографии (рис. 2) и РКТ органов грудной клетки обнаружен гидроторакс слева с явлениями ателектаза левого легкого. При повторной РКТ органов грудной брюшной полости отмечено увеличение периспленической гематомы до 8 × 8 × 6 см. С целью разрешения гидроторакса и ателектаза выполнено дренирование плевральной полости. В общей сложности удалено 1,35 л серозной жидкости соломенного цвета. По анализу выпота — экссудат. Через 4 суток пациентка была выписана, в течение 1 года наблюдения ее состояние не ухудшилось.

В заключение авторы указывают на возможность возникновения этого осложнения и анализируют его причины. Предполагаемые факторы — спленомегалия, предшествующие хирургические вмешательства, опухоли, дивертикулит, заболевания артерий. Потенциальным механизмом повреждения может стать тракция связочного аппарата селезенки, разрывы спаек в проекции селезенки или непосредственно травма.

image001.jpg
Рисунок 1 [1].

image003.jpg
Рисунок 2 [1].



[1] Suliman I., Guirguis J., Chyshkevych I., Dabage N.F. Splenic Injury with subsequent pleural effusion: an underreported complication of colonoscopy. Case Rep Gastroenterol. 2019. Jan 10; 13 (1): 6–11. DOI: 10.1159/000494917. eCollection 2019 Jan-Apr.

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Скрининговая колоноскопия — это стандартная процедура, которая проводится как в стационаре, так и в специализированных амбулаторных отделениях. Частота серьезных осложнений невысока и составляет не более 3 случаев на 1000 обследований. Наиболее частые осложнения после процедуры — перфорация и кровотечение. Повреждение селезенки — редкое осложнение с неизвестной частотой возникновения.

Повреждение селезенки после колоноскопии впервые было зарегистрировано и описано в 1974 году. Это жизнеугрожающее состояние, чаще всего требующее оперативного вмешательства — спленэктомии.

Американские врачи сообщают[1] о травме селезенки у здоровой 59-летней женщины в результате скрининговой колоноскопии после стандартной подготовки в условиях седации.

Ранее женщина перенесла несколько операций — холецистэктомию, два кесаревых сечения и гистерэктомию. В ходе колоноскопии патологий не было обнаружено, процедура прошла без особенностей. Приблизительно через 3 часа после исследования у пациентки появились острые боли в левом подреберье с иррадиацией в левое плечо. Боли в течение дня усиливались, возникло головокружение, общее состояние было предобморочным, что потребовало ее госпитализации.

При поступлении в стационар у пациентки отмечена гипотония — АД 73/38 мм рт. ст., ЧСС 75 ударов в минуту, уровень гемоглобина составлял 101 г/л. При РКТ органов брюшной полости выявлена гематома в области селезенки размером до 4 см (рис. 1). Поскольку экстравазация отсутствовала, было принято решение о консервативной терапии. В ходе лечения отмечалось снижение уровня гемоглобина до 73 г/л, что потребовало гемотрансфузии. Через 7 суток пациентка была выписана из стационара.

Еще через месяц женщина снова была госпитализирована с жалобами на одышку и боли в грудной клетке слева. Симптомы возникли через 2 недели после выписки из стационара. При рентгенографии (рис. 2) и РКТ органов грудной клетки обнаружен гидроторакс слева с явлениями ателектаза левого легкого. При повторной РКТ органов грудной брюшной полости отмечено увеличение периспленической гематомы до 8 × 8 × 6 см. С целью разрешения гидроторакса и ателектаза выполнено дренирование плевральной полости. В общей сложности удалено 1,35 л серозной жидкости соломенного цвета. По анализу выпота — экссудат. Через 4 суток пациентка была выписана, в течение 1 года наблюдения ее состояние не ухудшилось.

В заключение авторы указывают на возможность возникновения этого осложнения и анализируют его причины. Предполагаемые факторы — спленомегалия, предшествующие хирургические вмешательства, опухоли, дивертикулит, заболевания артерий. Потенциальным механизмом повреждения может стать тракция связочного аппарата селезенки, разрывы спаек в проекции селезенки или непосредственно травма.

image001.jpg
Рисунок 1 [1].

image003.jpg
Рисунок 2 [1].



[1] Suliman I., Guirguis J., Chyshkevych I., Dabage N.F. Splenic Injury with subsequent pleural effusion: an underreported complication of colonoscopy. Case Rep Gastroenterol. 2019. Jan 10; 13 (1): 6–11. DOI: 10.1159/000494917. eCollection 2019 Jan-Apr.

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=> N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Ссылка на оригинал [~DEFAULT_VALUE] => ) [EXCLUSIVE] => Array ( [ID] => 204 [TIMESTAMP_X] => 2018-12-17 13:58:20 [IBLOCK_ID] => 50 [NAME] => Материал эксклюзивен и будет опубликован только на EndoExpert.ru [ACTIVE] => Y [SORT] => 500 [CODE] => EXCLUSIVE [DEFAULT_VALUE] => [PROPERTY_TYPE] => L [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => C [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [VALUE_ENUM_ID] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Материал эксклюзивен и будет опубликован только на EndoExpert.ru [~DEFAULT_VALUE] => ) [CONCLUSION_OLD] => Array ( [ID] => 205 [TIMESTAMP_X] => 2019-04-24 17:03:02 [IBLOCK_ID] => 50 [NAME] => Вывод [ACTIVE] => Y [SORT] => 500 [CODE] => CONCLUSION_OLD [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Вывод [~DEFAULT_VALUE] => ) [COMMENTS] => Array ( [ID] => 206 [TIMESTAMP_X] => 2018-12-17 13:58:20 [IBLOCK_ID] => 50 [NAME] => Отключить комментарии [ACTIVE] => Y [SORT] => 500 [CODE] => COMMENTS [DEFAULT_VALUE] => [PROPERTY_TYPE] => L [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [VALUE_ENUM_ID] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Отключить комментарии [~DEFAULT_VALUE] => ) [VIDEO] => Array ( [ID] => 207 [TIMESTAMP_X] => 2019-03-10 13:28:07 [IBLOCK_ID] => 50 [NAME] => Видео [ACTIVE] => Y [SORT] => 500 [CODE] => VIDEO [DEFAULT_VALUE] => [PROPERTY_TYPE] => F [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Видео [~DEFAULT_VALUE] => ) [VIDEO_YOUTUBE] => Array ( [ID] => 208 [TIMESTAMP_X] => 2018-12-17 13:58:20 [IBLOCK_ID] => 50 [NAME] => You-tube видео [ACTIVE] => Y [SORT] => 500 [CODE] => VIDEO_YOUTUBE [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => You-tube видео [~DEFAULT_VALUE] => ) [FILE_PDF] => Array ( [ID] => 209 [TIMESTAMP_X] => 2019-01-10 21:44:24 [IBLOCK_ID] => 50 [NAME] => Файл PDF [ACTIVE] => Y [SORT] => 500 [CODE] => FILE_PDF [DEFAULT_VALUE] => [PROPERTY_TYPE] => F [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Файл PDF [~DEFAULT_VALUE] => ) [AUTHOR] => Array ( [ID] => 210 [TIMESTAMP_X] => 2019-04-24 16:45:40 [IBLOCK_ID] => 50 [NAME] => Автор [ACTIVE] => Y [SORT] => 500 [CODE] => AUTHOR [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => Y [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => Y [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Автор [~DEFAULT_VALUE] => ) [SHOW_COUNT] => Array ( [ID] => 221 [TIMESTAMP_X] => 2019-03-28 21:41:32 [IBLOCK_ID] => 50 [NAME] => Количество просмотров [ACTIVE] => Y [SORT] => 500 [CODE] => SHOW_COUNT [DEFAULT_VALUE] => [PROPERTY_TYPE] => N [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Количество просмотров [~DEFAULT_VALUE] => ) [SHOW_IN_INDEX] => Array ( [ID] => 226 [TIMESTAMP_X] => 2019-04-01 00:09:58 [IBLOCK_ID] => 50 [NAME] => Выводить на главной [ACTIVE] => Y [SORT] => 500 [CODE] => SHOW_IN_INDEX [DEFAULT_VALUE] => [PROPERTY_TYPE] => L [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => C [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [VALUE_ENUM_ID] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Выводить на главной [~DEFAULT_VALUE] => ) [READING_TIME] => Array ( [ID] => 234 [TIMESTAMP_X] => 2019-04-24 16:45:40 [IBLOCK_ID] => 50 [NAME] => Время прочтения в минутах [ACTIVE] => Y [SORT] => 500 [CODE] => READING_TIME [DEFAULT_VALUE] => [PROPERTY_TYPE] => N [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Время прочтения в минутах [~DEFAULT_VALUE] => ) [DATE] => Array ( [ID] => 235 [TIMESTAMP_X] => 2019-04-24 16:45:40 [IBLOCK_ID] => 50 [NAME] => Год [ACTIVE] => Y [SORT] => 500 [CODE] => DATE [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => Date [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Год [~DEFAULT_VALUE] => ) [CONCLUSION_SMALL] => Array ( [ID] => 236 [TIMESTAMP_X] => 2019-04-24 17:03:02 [IBLOCK_ID] => 50 [NAME] => Короткий вывод [ACTIVE] => Y [SORT] => 500 [CODE] => CONCLUSION_SMALL [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Короткий вывод [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [CONCLUSION] => Array ( [ID] => 237 [TIMESTAMP_X] => 2019-04-24 17:03:02 [IBLOCK_ID] => 50 [NAME] => Вывод [ACTIVE] => Y [SORT] => 500 [CODE] => CONCLUSION [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Вывод [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [ANNOTATION] => Array ( [ID] => 238 [TIMESTAMP_X] => 2019-04-24 17:04:34 [IBLOCK_ID] => 50 [NAME] => Аннотация [ACTIVE] => Y [SORT] => 500 [CODE] => ANNOTATION [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Аннотация [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [INTRODUCTION] => Array ( [ID] => 239 [TIMESTAMP_X] => 2019-04-24 17:04:34 [IBLOCK_ID] => 50 [NAME] => Введение [ACTIVE] => Y [SORT] => 500 [CODE] => INTRODUCTION [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Введение [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [PHOTOS] => Array ( [ID] => 240 [TIMESTAMP_X] => 2019-04-24 17:18:37 [IBLOCK_ID] => 50 [NAME] => Иллюстрации [ACTIVE] => Y [SORT] => 500 [CODE] => PHOTOS [DEFAULT_VALUE] => [PROPERTY_TYPE] => F [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => Y [XML_ID] => [FILE_TYPE] => jpg, gif, bmp, png, jpeg [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => Y [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Иллюстрации [~DEFAULT_VALUE] => ) [VIDEO_DESCRIPTION] => Array ( [ID] => 241 [TIMESTAMP_X] => 2019-04-24 18:21:05 [IBLOCK_ID] => 50 [NAME] => Описание видео [ACTIVE] => Y [SORT] => 500 [CODE] => VIDEO_DESCRIPTION [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Описание видео [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [BIBLIOGRAPHY] => Array ( [ID] => 242 [TIMESTAMP_X] => 2019-04-24 18:33:07 [IBLOCK_ID] => 50 [NAME] => Список литературы [ACTIVE] => Y [SORT] => 500 [CODE] => BIBLIOGRAPHY [DEFAULT_VALUE] => [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => Y [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => Y [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Список литературы [~DEFAULT_VALUE] => ) [FILE_PUBL] => Array ( [ID] => 243 [TIMESTAMP_X] => 2019-04-24 18:53:00 [IBLOCK_ID] => 50 [NAME] => Публикация в электронном виде [ACTIVE] => Y [SORT] => 500 [CODE] => FILE_PUBL [DEFAULT_VALUE] => [PROPERTY_TYPE] => F [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Публикация в электронном виде [~DEFAULT_VALUE] => ) [ARCHIVE_PUBL] => Array ( [ID] => 244 [TIMESTAMP_X] => 2019-04-24 18:53:00 [IBLOCK_ID] => 50 [NAME] => Архив материалов к публикации [ACTIVE] => Y [SORT] => 500 [CODE] => ARCHIVE_PUBL [DEFAULT_VALUE] => [PROPERTY_TYPE] => F [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Архив материалов к публикации [~DEFAULT_VALUE] => ) [SPONSOR] => Array ( [ID] => 245 [TIMESTAMP_X] => 2019-04-24 19:10:36 [IBLOCK_ID] => 50 [NAME] => Материал опубликован при поддержке [ACTIVE] => Y [SORT] => 500 [CODE] => SPONSOR [DEFAULT_VALUE] => [PROPERTY_TYPE] => E [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => Y [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 44 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => [USER_TYPE_SETTINGS] => [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Материал опубликован при поддержке [~DEFAULT_VALUE] => ) [ENDOEXPERT] => Array ( [ID] => 246 [TIMESTAMP_X] => 2019-04-24 19:21:23 [IBLOCK_ID] => 50 [NAME] => От редакции EndoExpert.ru [ACTIVE] => Y [SORT] => 500 [CODE] => ENDOEXPERT [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => От редакции EndoExpert.ru [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [BIBLIOGRAPHY_ALL] => Array ( [ID] => 247 [TIMESTAMP_X] => 2019-05-01 10:55:11 [IBLOCK_ID] => 50 [NAME] => Список литературы [ACTIVE] => Y [SORT] => 500 [CODE] => BIBLIOGRAPHY_ALL [DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) [PROPERTY_TYPE] => S [ROW_COUNT] => 1 [COL_COUNT] => 30 [LIST_TYPE] => L [MULTIPLE] => N [XML_ID] => [FILE_TYPE] => [MULTIPLE_CNT] => 5 [TMP_ID] => [LINK_IBLOCK_ID] => 0 [WITH_DESCRIPTION] => N [SEARCHABLE] => N [FILTRABLE] => N [IS_REQUIRED] => N [VERSION] => 1 [USER_TYPE] => HTML [USER_TYPE_SETTINGS] => Array ( [height] => 200 ) [HINT] => [PROPERTY_VALUE_ID] => [VALUE] => [DESCRIPTION] => [VALUE_ENUM] => [VALUE_XML_ID] => [VALUE_SORT] => [~VALUE] => [~DESCRIPTION] => [~NAME] => Список литературы [~DEFAULT_VALUE] => Array ( [TEXT] => [TYPE] => HTML ) ) [PDF_TO_IMG] => Array ( [ID] => 508 [TIMESTAMP_X] => 2019-06-06 23:03:40 [IBLOCK_ID] => 50 [NAME] => Cделать фото из пдф для превью [ACTIVE] => Y [SORT] => 500 [CODE] => PDF_TO_IMG [DEFAULT_VALUE] => [PROPERTY_TYPE] => L 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Статьи: ПОВРЕЖДЕНИЕ СЕЛЕЗЕНКИ КАК ОСЛОЖНЕНИЕ

Полный текст статьи:

Скрининговая колоноскопия — это стандартная процедура, которая проводится как в стационаре, так и в специализированных амбулаторных отделениях. Частота серьезных осложнений невысока и составляет не более 3 случаев на 1000 обследований. Наиболее частые осложнения после процедуры — перфорация и кровотечение. Повреждение селезенки — редкое осложнение с неизвестной частотой возникновения.

Повреждение селезенки после колоноскопии впервые было зарегистрировано и описано в 1974 году. Это жизнеугрожающее состояние, чаще всего требующее оперативного вмешательства — спленэктомии.

Американские врачи сообщают[1] о травме селезенки у здоровой 59-летней женщины в результате скрининговой колоноскопии после стандартной подготовки в условиях седации.

Ранее женщина перенесла несколько операций — холецистэктомию, два кесаревых сечения и гистерэктомию. В ходе колоноскопии патологий не было обнаружено, процедура прошла без особенностей. Приблизительно через 3 часа после исследования у пациентки появились острые боли в левом подреберье с иррадиацией в левое плечо. Боли в течение дня усиливались, возникло головокружение, общее состояние было предобморочным, что потребовало ее госпитализации.

При поступлении в стационар у пациентки отмечена гипотония — АД 73/38 мм рт. ст., ЧСС 75 ударов в минуту, уровень гемоглобина составлял 101 г/л. При РКТ органов брюшной полости выявлена гематома в области селезенки размером до 4 см (рис. 1). Поскольку экстравазация отсутствовала, было принято решение о консервативной терапии. В ходе лечения отмечалось снижение уровня гемоглобина до 73 г/л, что потребовало гемотрансфузии. Через 7 суток пациентка была выписана из стационара.

Еще через месяц женщина снова была госпитализирована с жалобами на одышку и боли в грудной клетке слева. Симптомы возникли через 2 недели после выписки из стационара. При рентгенографии (рис. 2) и РКТ органов грудной клетки обнаружен гидроторакс слева с явлениями ателектаза левого легкого. При повторной РКТ органов грудной брюшной полости отмечено увеличение периспленической гематомы до 8 × 8 × 6 см. С целью разрешения гидроторакса и ателектаза выполнено дренирование плевральной полости. В общей сложности удалено 1,35 л серозной жидкости соломенного цвета. По анализу выпота — экссудат. Через 4 суток пациентка была выписана, в течение 1 года наблюдения ее состояние не ухудшилось.

В заключение авторы указывают на возможность возникновения этого осложнения и анализируют его причины. Предполагаемые факторы — спленомегалия, предшествующие хирургические вмешательства, опухоли, дивертикулит, заболевания артерий. Потенциальным механизмом повреждения может стать тракция связочного аппарата селезенки, разрывы спаек в проекции селезенки или непосредственно травма.

image001.jpg
Рисунок 1 [1].

image003.jpg
Рисунок 2 [1].



[1] Suliman I., Guirguis J., Chyshkevych I., Dabage N.F. Splenic Injury with subsequent pleural effusion: an underreported complication of colonoscopy. Case Rep Gastroenterol. 2019. Jan 10; 13 (1): 6–11. DOI: 10.1159/000494917. eCollection 2019 Jan-Apr.

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