Differential diagnosis and therapy of the acute abdomen in sickle cell crisis: A rare case in general surgery in Germany

Surgical therapy of the acute abdomen often allows only limited time for di fferential diagnosis to confirm the indication for surgery. Under considera tion of clinical aspects and case history both common and rare causes of an acute abdomen should be investigated without undue loss of time. Different ial diagnostic considerations and eventual therapy are presented in the fol lowing case of a 25-year-old Afroamerican who developed multiorgan failure after an initial course of lower-back pain. In addition to the clinical set ting of an acute abdomen the patient presented with acute respiratory failu re and laboratory signs of severe hemolysis in combination with newly detec ted splenomegaly. The indication for splenectomy was made following CT-prov en complete splenic infarction due to repeated acute squestration. Histolog ic examination of the spleen together with hemoglobin electrophoresis confi rmed the clinical assumption of unusually late primary manifestation of a s ickle cell crisis. In the underlying case, the hemoglobinopathy was in fact the less common form of combined sickle-cell-P-thalassemia. A ten-day cour se of intensive care therapy was necessary to treat ongoing multiorgan fail ure due to persistent sickle cell crisis. Current diagnostic and therapeuti c procedures in connection with sickle cell crisis as a rare cause of an ac ute abdomen with the necessity for surgical intervention are presented.