RESUMEN
Splenic artery pseudoaneurysm (SAP) is an uncommon etiology of acute abdominal pain, requiring a high degree of clinical suspicion to diagnose in a timely manner. There are currently no reports of spontaneous SAP ruptures in the emergency medicine literature. We report a case of a man who presented with acute abdominal pain secondary to an SAP. A computed tomography angiography scan of the abdomen revealed a ruptured SAP with hemoperitoneum. He successfully underwent emergency laparotomy and surgical ligation of his SAP with splenectomy. SAP rupture remains an under-recognized etiology of abdominal pain, even though it is the most frequent type of visceral pseudoaneurysm. Our case herein reinforces the importance of a broad list of differential diagnoses in the patient with acute abdominal pain, as well as the importance of the emergency physician in identifying an emergent condition and then directing the initial stabilization, resuscitation, and management.
RESUMEN
Bupropion overdose in the pediatric setting poses significant potential for toxicity. We present the case of a 15-year-old female patient presenting with intentional bupropion overdose resulting in generalized tonic-clonic seizures, severe acidosis, vomiting, and tachycardia after ingestion of between 1,650 to 9,000 mg (24-133 mg/kg) of bupropion. The patient was admitted to pediatric intensive care unit (PICU) where toxicity was resolved promptly following administration of intravenous lipid emulsion (ILE) infusion. ILE is a first-line treatment for other forms of toxicity including unintended local anesthetic administration. ILE use is not a first-line treatment in this setting, but this case presents a positive subsequent patient outcome.