Spontaneous splenic rupture in a patient receiving thrombolytic therapy

• Autor(a) principal: Revesz,Elizabeth
• Data de Publicação: 2009
• Outros Autores: Grimaldi,John A., Clark,Elizabeth T., Podbielski,Francis J.
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Jornal Vascular Brasileiro (Online)
• Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1677-54492009000300016
• topic: Splenic rupture; spontaneous splenic rupture; tissue plasminogen activator; t-PA; thrombolytic therapy

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.