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A case of splenic rupture: a rare event after laparoscopic cholecystectomy.

Geraci G, Picciurro A, Attard A, Modica G, Cajozzo M, Sciumè C - BMC Surg (2014)

Bottom Line: Clinical examination revealed hypovolemic shock.We postulate that congenital or post-traumatic adhesions of the parietal peritoneum to the spleen may have been stretched from the splenic capsule during pneumoperitoneum establishment, resulting in subcapsular hematoma and subsequent delayed rupture.Direct visualization of the spleen at the end of LC might be a useful procedure to aid early recognition and management in such cases.

View Article: PubMed Central - PubMed

Affiliation: School of Medicine and Surgery, Section of General and Thoracic Surgery (Chief: Giuseppe Modica, MD), University Hospital of Palermo, Via Liborio Giuffrè, 5, 90127 Palermo, Sicily, Italy. girolamo.geraci@unipa.it.

ABSTRACT

Background: Laparoscopic cholecystectomy (LC) is generally safe and well-accepted. In rare cases, it is associated with complications (intra- e postoperative bleeding, visceral injury and surgical site infection). Splenic lesion has been reported only after direct trauma. We report an unusual case of splenic rupture presenting after "uncomplicated" LC.

Case presentation: A 77-year-old woman presented with distended abdomen, tenderness in the left upper quadrant and severe anemia 12 hours after LC. Clinical examination revealed hypovolemic shock. Abdominal computed tomography confirmed the diagnosis of splenic rupture, and the patient required an urgent splenectomy through midline incision. The post-operative course was uneventful and the patient was discharged on 7th postoperative day.Splenic injury rarely complicates LC. We postulate that congenital or post-traumatic adhesions of the parietal peritoneum to the spleen may have been stretched from the splenic capsule during pneumoperitoneum establishment, resulting in subcapsular hematoma and subsequent delayed rupture.

Conclusions: Splenic rupture is an unusual but life-threatening complication of LC. Direct visualization of the spleen at the end of LC might be a useful procedure to aid early recognition and management in such cases.

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Related in: MedlinePlus

CT showing severe haemoperitoneum with two major blood collections localized respectively along the course of hepato-gastric ligament (a) and in the left sub-phrenic space (b).
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Fig1: CT showing severe haemoperitoneum with two major blood collections localized respectively along the course of hepato-gastric ligament (a) and in the left sub-phrenic space (b).

Mentions: Immediately blood tests were performed showing a severe anemia (hypovolemic shock): the Hemoglobin decreased from preoperative 10.4 gr/dl to 5.3 gr/dl and red blood cell from 3.6×106/μl to 1.7×106/μl. We performed an urgent computed tomography (CT) that showed severe haemoperitoneum with two major blood collections localized respectively along the course of hepato-gastric ligament (16×5 cm) and in the left sub-phrenic space (with active spreading of contrast medium) (Figure 1).Figure 1


A case of splenic rupture: a rare event after laparoscopic cholecystectomy.

Geraci G, Picciurro A, Attard A, Modica G, Cajozzo M, Sciumè C - BMC Surg (2014)

CT showing severe haemoperitoneum with two major blood collections localized respectively along the course of hepato-gastric ligament (a) and in the left sub-phrenic space (b).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4279895&req=5

Fig1: CT showing severe haemoperitoneum with two major blood collections localized respectively along the course of hepato-gastric ligament (a) and in the left sub-phrenic space (b).
Mentions: Immediately blood tests were performed showing a severe anemia (hypovolemic shock): the Hemoglobin decreased from preoperative 10.4 gr/dl to 5.3 gr/dl and red blood cell from 3.6×106/μl to 1.7×106/μl. We performed an urgent computed tomography (CT) that showed severe haemoperitoneum with two major blood collections localized respectively along the course of hepato-gastric ligament (16×5 cm) and in the left sub-phrenic space (with active spreading of contrast medium) (Figure 1).Figure 1

Bottom Line: Clinical examination revealed hypovolemic shock.We postulate that congenital or post-traumatic adhesions of the parietal peritoneum to the spleen may have been stretched from the splenic capsule during pneumoperitoneum establishment, resulting in subcapsular hematoma and subsequent delayed rupture.Direct visualization of the spleen at the end of LC might be a useful procedure to aid early recognition and management in such cases.

View Article: PubMed Central - PubMed

Affiliation: School of Medicine and Surgery, Section of General and Thoracic Surgery (Chief: Giuseppe Modica, MD), University Hospital of Palermo, Via Liborio Giuffrè, 5, 90127 Palermo, Sicily, Italy. girolamo.geraci@unipa.it.

ABSTRACT

Background: Laparoscopic cholecystectomy (LC) is generally safe and well-accepted. In rare cases, it is associated with complications (intra- e postoperative bleeding, visceral injury and surgical site infection). Splenic lesion has been reported only after direct trauma. We report an unusual case of splenic rupture presenting after "uncomplicated" LC.

Case presentation: A 77-year-old woman presented with distended abdomen, tenderness in the left upper quadrant and severe anemia 12 hours after LC. Clinical examination revealed hypovolemic shock. Abdominal computed tomography confirmed the diagnosis of splenic rupture, and the patient required an urgent splenectomy through midline incision. The post-operative course was uneventful and the patient was discharged on 7th postoperative day.Splenic injury rarely complicates LC. We postulate that congenital or post-traumatic adhesions of the parietal peritoneum to the spleen may have been stretched from the splenic capsule during pneumoperitoneum establishment, resulting in subcapsular hematoma and subsequent delayed rupture.

Conclusions: Splenic rupture is an unusual but life-threatening complication of LC. Direct visualization of the spleen at the end of LC might be a useful procedure to aid early recognition and management in such cases.

Show MeSH
Related in: MedlinePlus