Non-thoracic Source of Bleeding During Left-sided Thoracic Surgery

Abstract

Hypotension during thoracic surgery is traditionally attributed to intrathoracic causes such as pulmonary bleeding, ventilation, causing decreased venous return, and a decrease in myocardial contractility. We present a case of unexplained hypotension presenting at the end of left-sided thoracic surgery. The cause of hypotension was ultimately found to be due to intra-abdominal bleeding from a splenic injury. This case reminds the anesthesiologist to be vigilant of non-thoracic causes of hypotension during left-sided lung surgery.

Splenic rupture after surgical fixation of rib fractures with video-assisted thoracoscopic surgery: A case report

“…Complications following SSRF include surgery- and implant-related complications, such as bleeding, wound infection, fracture-related infection, revision surgery, breakage, mechanical failure, and irritation; bone-healing complications, including nonunion and malunion; and pulmonary complications, such as pneumonia, excess pleural fluid, hemothorax, pneumothorax, tension pneumothorax, empyema, tracheostomy, and ARDS [ 10 ]. Although there have been no reports of splenic rupture after SSRF, several reports have described splenic rupture after thoracoscopy or thoracotomy for elective lung surgery [ [11] , [12] , [13] , [14] ]. According to these reports, the mechanisms of splenic rupture are speculated to be due to various factors, including the spleen being compressed by violent coughing, sudden and forceful Valsalva maneuvers, disruption of adhesions between the spleen and diaphragm due to intrathoracic manipulation, changes of body positions during surgery, and left diaphragm elevation due to anatomical changes of the thoracic cage after lung resection.…”