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Atraumatic splenic rupture cases presenting with hemorrhagic shock and coagulopathy treated by splenic artery occlusion using a microballoon catheter before splenectomy.

Matsumura Y, Matsumoto J, Kurita T, Oshima T, Hattori N, Toma T, Teeter WA, Oda S - J Surg Case Rep (2015)

Bottom Line: Atraumatic splenic rupture (ASR) is an uncommon pathologic condition in which bleeding from the spleen occurs for a variety of nontraumatic reasons.In this report, we describe two cases of ASR presenting with hemorrhagic shock and complicated by anticoagulation therapy.Our successful treatment of these patients included a three-step strategy as a damage control: (i) rapid transient hemostasis by splenic artery occlusion using a microballoon catheter, (ii) damage control resuscitation and (iii) splenectomy as a definitive hemostatic treatment.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan yousuke.jpn4035@gmail.com.

No MeSH data available.


Related in: MedlinePlus

The right gastroepiploic artery with platinum coils after embolization. The microballoon catheter was placed in the splenic artery (arrow).
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RJV121F2: The right gastroepiploic artery with platinum coils after embolization. The microballoon catheter was placed in the splenic artery (arrow).

Mentions: A 66-year-old man presented after suffering sudden hypotension and abdominal distension, followed by a rapid and progressive anemia. After arriving at hospital, he collapsed and went into cardiac arrest. Return of spontaneous circulation occurred after 36 min of cardiopulmonary resuscitation and rapid blood transfusion. Abdominal contrast-enhanced computed tomography (CECT) revealed a large hematoma around the spleen and liver, in paracolic gutters and the pelvis with active arterial extravasation and apparent capsular disruption (Fig. 1). He was transferred to our hospital for definitive, emergency hemostasis. At admission, his systolic blood pressure (BP) was 90 mmHg; heart rate (HR), 80 bpm; hemoglobin (Hb) level, 6.7 g/dl; hematocrit (Ht), 19.0%; prothrombin time-international normalized ratio (PT-INR), 2.16 and activated partial thromboplastin time (APTT), 63.9 s (under massive transfusion). He was currently on warfarin therapy for anticoagulation following a total aortic arch replacement including aortic valve replacement at the age of 60. He presented with no history of trauma, and Moraxella catarrhalis had been detected in a blood culture taken on initial presentation. We made a diagnosis of ASR secondary to infection exacerbated by anticoagulation therapy. We first planned to perform a splenectomy as a definitive hemostatic treatment. However, his transfusion requirement was massive and the risk of significantly worsened hemorrhage during any operative procedure was increased by his iatrogenic coagulopathy. After discussion with surgery team and interventional radiology (IR) team, transient occlusion of the splenic artery using a microballoon catheter was performed (LOGOS, Piolax, Inc., Kanagawa, Japan; arrival to occlusion, 90 min; arrival to angiography suite, 60 min; procedure time to occlusion, 15 min; Fig. 2). Soon after balloon occlusion, the patient's hemodynamic state improved and his anemia stabilized. Perioperatively, 6 units of red cell concentrate (RCC) and 10 units of fresh frozen plasma (FFP) were transfused. The patient's coagulopathy improved on hospital Day 2 (Ht, 25%; PT-INR, 1.35 and APTT, 33.5 s) and was taken to the operating theater for open splenectomy. The spleen was swollen and capsular rupture was indeed identified, but there was no finding of a solid tumor or abscess formation. Bone marrow aspiration did not reveal any evidence of a hematological disorder. There was no subsequent hemorrhage postoperatively. He was extubated on Day 4, and was discharged from the ICU on Day 6. The patient was transferred to another hospital on Day 25 without residual deficits or complications from his cardiac arrest.Figure 1:


Atraumatic splenic rupture cases presenting with hemorrhagic shock and coagulopathy treated by splenic artery occlusion using a microballoon catheter before splenectomy.

Matsumura Y, Matsumoto J, Kurita T, Oshima T, Hattori N, Toma T, Teeter WA, Oda S - J Surg Case Rep (2015)

The right gastroepiploic artery with platinum coils after embolization. The microballoon catheter was placed in the splenic artery (arrow).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4593998&req=5

RJV121F2: The right gastroepiploic artery with platinum coils after embolization. The microballoon catheter was placed in the splenic artery (arrow).
Mentions: A 66-year-old man presented after suffering sudden hypotension and abdominal distension, followed by a rapid and progressive anemia. After arriving at hospital, he collapsed and went into cardiac arrest. Return of spontaneous circulation occurred after 36 min of cardiopulmonary resuscitation and rapid blood transfusion. Abdominal contrast-enhanced computed tomography (CECT) revealed a large hematoma around the spleen and liver, in paracolic gutters and the pelvis with active arterial extravasation and apparent capsular disruption (Fig. 1). He was transferred to our hospital for definitive, emergency hemostasis. At admission, his systolic blood pressure (BP) was 90 mmHg; heart rate (HR), 80 bpm; hemoglobin (Hb) level, 6.7 g/dl; hematocrit (Ht), 19.0%; prothrombin time-international normalized ratio (PT-INR), 2.16 and activated partial thromboplastin time (APTT), 63.9 s (under massive transfusion). He was currently on warfarin therapy for anticoagulation following a total aortic arch replacement including aortic valve replacement at the age of 60. He presented with no history of trauma, and Moraxella catarrhalis had been detected in a blood culture taken on initial presentation. We made a diagnosis of ASR secondary to infection exacerbated by anticoagulation therapy. We first planned to perform a splenectomy as a definitive hemostatic treatment. However, his transfusion requirement was massive and the risk of significantly worsened hemorrhage during any operative procedure was increased by his iatrogenic coagulopathy. After discussion with surgery team and interventional radiology (IR) team, transient occlusion of the splenic artery using a microballoon catheter was performed (LOGOS, Piolax, Inc., Kanagawa, Japan; arrival to occlusion, 90 min; arrival to angiography suite, 60 min; procedure time to occlusion, 15 min; Fig. 2). Soon after balloon occlusion, the patient's hemodynamic state improved and his anemia stabilized. Perioperatively, 6 units of red cell concentrate (RCC) and 10 units of fresh frozen plasma (FFP) were transfused. The patient's coagulopathy improved on hospital Day 2 (Ht, 25%; PT-INR, 1.35 and APTT, 33.5 s) and was taken to the operating theater for open splenectomy. The spleen was swollen and capsular rupture was indeed identified, but there was no finding of a solid tumor or abscess formation. Bone marrow aspiration did not reveal any evidence of a hematological disorder. There was no subsequent hemorrhage postoperatively. He was extubated on Day 4, and was discharged from the ICU on Day 6. The patient was transferred to another hospital on Day 25 without residual deficits or complications from his cardiac arrest.Figure 1:

Bottom Line: Atraumatic splenic rupture (ASR) is an uncommon pathologic condition in which bleeding from the spleen occurs for a variety of nontraumatic reasons.In this report, we describe two cases of ASR presenting with hemorrhagic shock and complicated by anticoagulation therapy.Our successful treatment of these patients included a three-step strategy as a damage control: (i) rapid transient hemostasis by splenic artery occlusion using a microballoon catheter, (ii) damage control resuscitation and (iii) splenectomy as a definitive hemostatic treatment.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan yousuke.jpn4035@gmail.com.

No MeSH data available.


Related in: MedlinePlus