Atraumatic splenic rupture in a patient treated with rivaroxaban: A case report and a narrative review

Abstract

Atraumatic splenic rupture (ASR) is a rare condition mostly associated with neoplastic, infectious, and inflammatory diseases. ASR associated with drug treatment is even rarer. In this case report, we highlight an unusual complication of the direct oral anticoagulant rivaroxaban. A 64‐year‐old male patient was admitted to the emergency department with complaints of faintness and diffuse abdominal cramps. The patient had no history of recent trauma. Clinical examination revealed hemodynamic instability with a moderate response to filling and mild abdominal discomfort on palpation. His medical history included chronic hypertension, constipation, and recent atrial flutter ablation. The patient was taking amiodarone, bisoprolol, atorvastatin, and rivaroxaban. Splenic rupture was diagnosed several hours later on contrast‐enhanced abdominal computed tomography scan. Massive blood transfusions and emergency laparotomy for splenectomy were performed. Anatomopathological analysis did not reveal any neoplastic, inflammatory, or infectious causes. The patient was successfully discharged from the intensive care unit 3 days later. Clinicians must consider the possibility of ASR as a complication of rivaroxaban in patients with abdominal tenderness and hemodynamic instability. Unfortunately, clinical presentation is not always typical of a ruptured spleen. Delayed diagnosis can be life threatening or fatal. Splenectomy via laparotomy remains the best therapeutic option in cases of splenic rupture in unstable patients on direct oral anticoagulants.

Atraumatic Splenic Rupture in a Neonate: A Case Report

“…2 Due to the absence of trauma to abdomen, ASR may involve delayed or missed diagnosis and treatment, resulting in fatal outcomes. 6 ASR is associated with about 12% of mortality rate. 6 Thus, like its traumatic counterpart, ASR also requires urgent medical attention to avoid negative patient outcome.…”

“…6 ASR is associated with about 12% of mortality rate. 6 Thus, like its traumatic counterpart, ASR also requires urgent medical attention to avoid negative patient outcome. 3 Splenectomy appears to be the most common treatment method for ASR.…”

“…Atraumatic splenic rupture is a rare condition, but it can happen at any stage of life. [1][2][3][4][5][6][7] Due to its rarity, the pathogenesis of ASR is not well understood. Therefore, it is encouraged that ASR cases should be reported to gain further insight into the condition.…”

“…Atraumatic splenic rupture is idiopathic and presumed to be caused by many factors, including malignancy, infection, systemic or local inflammation, and anticoagulant drug usage. [1][2][3][4][5][6][7] The presentation of ASR may involve the pentad of abdominal distension, hypovolemic shock, anemia, active bleeding, and hemoperitoneum. Although abdominal distension may be a clinical sign and noted during a physical exam, diagnostic imaging is most helpful to investigate the last two symptoms.…”

“…The retrospective analyses of patient cases of ASR relate the condition to the presence of neoplasm, infection, inflammatory diseases, and the usage of anticoagulant drugs. [1][2][3][4][5][6][7] The case presented involves a neonate, who was probably negatively affected by her mother's medical conditions.…”