Spontaneous splenic rupture in a patient receiving thrombolytic therapy

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.

Atraumatic Splenic Rupture after Myocardial Infarction

“…Several cases of spontaneous splenic rupture have been reported with unfractionated heparin, low molecular weight heparin [3] , warfarin [4] and novel oral anticoagulants [5,6] in a previously described normal spleen. As expected, thrombolytic therapy, including both streptokinase and recombinant tissue plasminogen activator [7] , have also been implicated. Our literature search identified only two case reports [8,9] attributing dual antiplatelet therapy (aspirin with ticagrelor and aspirin with clopidogrel) to spontaneous splenic rupture.…”