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
PDF
SciELO
Downloads: 1
Views: 813

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

References

Atkinson E. Death from idiopathic rupture of the spleen. Br Med J. 1874;2:403-4.

Lieberman ME, Levitt A. Spontaneous rupture of the spleen. Am J Emerg Med. 1989;7:28-31.

Blakenship JC, Indeck M. Spontaneous splenic rupture after t-PA for acute myocardial infarction [letter]. N Engl J Med. 1991;325:969.

Cheung PK, Arnold JM, McLarty TD. Splenic hemorrhage: a complication of tissue plasminogen activator treatment. Can J Cardiol. 1990;6:183-5.

Weiner RS, Ong LS. Streptokinase and splenic rupture [brief clinical observation]. Am J Med. 1989;86:249.

Gardner-Medwin J, Sayer J, Mahida YR, Spiller RC. Spontaneous rupture of spleen following streptokinase therapy. Lancet. 1989;2:1398.

Eklof B, Jones JE, Lohi A, Staszkiewicz W, Norgren L. Spontaneous rupture of liver and spleen with severe intra-abdominal bleeding during streptokinase treatment of DVT. Vasa. 1977;6:369-71.

Hibbard LT. Spontaneous rupture of the liver in pregnancy: a report of eight cases. Am J Obstet Gynecol. 1976;126:334-8.

Toubia NT, Tawk MM, Potts RM, Kinasewitz GT. Cough and spontaneous rupture of a normal spleen. Chest. 2005;128:1884-6.

Lennard TW, Burgess P. Vomiting and 'spontaneous' rupture of the spleen. Br J Clin Pract. 1985;39:407.

Kumar N, A. Robbins & Cotran pathologic basis of disease. 2004.

Tissue plasminogen activator for the treatment of acute pulmonary embolism. A collaborative study by the PIOPED Investigators. Chest. 1990;97:528-33.

Brunicardi FC, Andersen DK, Billiar TR. Principles of surgery. 2005.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
5ddfc0630e88258a6b4ce1d5 jvb Articles
Links & Downloads
1677-7301 (Electronic)
J Vasc Bras ©2024 All rights reserved.

J Vasc Bras

Share this page
Page Sections