Spontaneous Splenic Rupture Four Days after an Open Appendicectomy

Parker, R; Gravante, Gianpiero; Elshaer, Mohamed; Humayun, Nada; Ebdewi, Hamdi

doi:10.1308/003588414x14055925060550

Cited by 1 publication

(1 citation statement)

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“…10 Splenic ruptures specifically following laparoscopic proce- CRSLS MIS Case Reports from SLS.org dures have been reported, with case reports hypothesizing that the traction on the spleen (either from adhesions or from the pneumoperitoneum at induction) is strong enough to cause rupture. 11 Splenic injury has been reported after nephrectomy as well: recent studies have estimated that left nephrectomies are complicated by iatrogenic splenectomy in 4.3-13.2% of cases. 12 In these instances, however, the mechanism of injury is attributed to either traction or injury from surgical instruments themselves.…”

Section: Discussionmentioning

confidence: 99%

Delayed Splenic Rupture after Robotic Partial Nephrectomy

Gogel¹,

Zaveri²,

Dickstein³

et al. 2020

CRSLS

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Introduction: Splenic rupture can be classified as traumatic, pathologic, or spontaneous. Spontaneous splenic rupture is rare, and accounts for only 1% of cases. Most cases of spontaneous splenic rupture involve a histopathologically abnormal spleen, but in rare cases, rupture of the spleen can occur in the absence of underlying disease or trauma. We present a case of delayed spontaneous splenic rupture in the postoperative setting following a partial nephrectomy.Case Description: A 54-y-old man presented with abdominal pain, dysuria, fever, and chills 1 week after a robotic left partial nephrectomy. An initial computed tomography scan showed no evidence of splenic injury, and he was admitted for suspected pyelonephritis. A computed tomography scan was obtained 4 d later for worsening pain and fever and revealed a 14-cm subcapsular hematoma of the spleen extending to the gastrohepatic ligament. He underwent an emergent angiogram and embolization of an actively bleeding splenic artery and inferior phrenic artery. A second embolization was required 2 d later to control ongoing bleeding. He then developed increased abdominal pain with nausea, vomiting, and continued leukocytosis secondary to a completely infarcted and necrotic spleen. A laparoscopic, hand-assisted splenectomy was performed successfully, and he was eventually discharged in stable condition. Conclusion:Spontaneous splenic rupture is extremely rare, particularly in the postoperative setting. It is possible that some of these cases are in fact secondary to occult trauma to the spleen during surgery. Prompt diagnosis and management, often with emergent splenectomy, is critical in these cases. Minimally invasive surgery is a feasible option for splenic resection in cases of spontaneous splenic rupture.

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Section: Discussionmentioning

confidence: 99%