Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/S1677-54492009005000015
Jornal Vascular Brasileiro
Case report

Spontaneous splenic rupture in a patient receiving thrombolytic therapy

Elizabeth Revesz; John A. Grimaldi; Elizabeth T. Clark; Francis J. Podbielski

http://dx.doi.org/10.1590/S1677-54492009005000015 J Vasc Bras, vol.8, n3, p.274-276, 2009
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Abstract

We describe the case of a 67-year-old female patient with a history of femoral-distal bypass graft with sudden onset of unremitting leg pain, who had recently received tissue plasminogen activator (t-PA). The patient reported non-compliance with her warfarin regimen. Angiography revealed occlusion of the bypass graft. Infusion of t-PA was performed via a right femoral artery approach. On hospital day two, the patient developed nausea and abdominal pain with associated hypotension. A CT scan showed a massive intra-abdominal and pelvic free fluid consistent with blood. The spleen was enlarged and fluid noted around the liver. At laparotomy, a grade III splenic laceration at the hilum was identified and a splenectomy performed. The patient recovered completely. Although rare, spontaneous splenic rupture should be considered in the differential diagnosis of patients undergoing thrombolytic therapy who develop signs of hemodynamic instability.

Keywords

Splenic rupture, spontaneous splenic rupture, tissue plasminogen activator, t-PA, thrombolytic therapy

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