Ten days after Splenectomy for blunt abdominal trauma, a 23- year-old man complains of upper abdominal and lower chest pain exacerbated by deep breathing. He is anorectic but ambulatory and otherwise making satisfactory progress. On examination his temperature is38.20C and he has decreased breath sounds at left lung base. His abdominal wound appears to be healing well, bowel sounds are active and there are no peritoneal signs. Digital rectal examination is negative. WBC 12,500/mm3 with a shift to left. CXR show ‘plate like’ atelectasis of the left lung field. Abdominal radiograph shows a non-specific gas pattern in bowel and an air-fluid level in LUQ. Serum Amylase is 150 Somogyi units per dL. The most likely diagnosis is:
Ten days after Splenectomy for blunt abdominal trauma, a 23- year-old man complains of upper abdominal and lower chest pain exacerbated by deep breathing. He is anorectic but ambulatory and otherwise making satisfactory progress. On examination his temperature is38.20C and he has decreased breath sounds at left lung base. His abdominal wound appears to be healing well, bowel sounds are active and there are no peritoneal signs. Digital rectal examination is negative. WBC 12,500/mm3 with a shift to left. CXR show ‘plate like’ atelectasis of the left lung field. Abdominal radiograph shows a non-specific gas pattern in bowel and an air-fluid level in LUQ. Serum Amylase is 150 Somogyi units per dL. The most likely diagnosis is:
💡 Explanation
## **Core Concept**
The question tests the ability to diagnose postoperative complications, specifically focusing on respiratory and abdominal symptoms following splenectomy. The clinical presentation suggests a condition that involves both pulmonary and gastrointestinal systems, likely related to the recent surgery.
## **Why the Correct Answer is Right**
The patient's symptoms of upper abdominal and lower chest pain exacerbated by deep breathing, decreased breath sounds at the left lung base, and the radiographic finding of 'plate-like' atelectasis of the left lung field indicate a pulmonary complication. The presence of an air-fluid level in the left upper quadrant (LUQ) on the abdominal radiograph and a non-specific gas pattern in the bowel, along with elevated WBC count and fever, points towards an abdominal involvement. The elevated serum amylase level (150 Somogyi units per dL) is a critical clue. Given these findings, the most likely diagnosis is **postoperative pancreatitis**. This condition can occur after abdominal surgery, including splenectomy, due to various factors such as surgical trauma to the pancreas or its blood supply, or due to the activation of pancreatic enzymes.
## **Why Each Wrong Option is Incorrect**
- **Option A:** Without specific details on the option, we cannot directly address its incorrectness, but any option not leading to a diagnosis like postoperative pancreatitis would not adequately explain the combination of pulmonary and abdominal findings along with elevated serum amylase.
- **Option B:** Similarly, without specifics, any alternative diagnosis not aligning with the clinical and radiographic findings provided would be incorrect.
- **Option C:** This option is not provided, but presumably, it does not fit the clinical picture as well as the correct answer.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that **postoperative pancreatitis** can present with atypical symptoms, especially in the early stages, and may not always have the classic presentation of severe abdominal pain. The elevation of serum amylase and lipase levels, along with clinical and radiographic findings, is crucial for the diagnosis. Postoperative patients, especially after surgeries close to the pancreas like splenectomy, should be monitored for signs of pancreatitis.
## **Correct Answer:** D. Postoperative pancreatitis.
✓ Correct Answer: A. Subphrenic abscess
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